Improving Mental Health Inpatient Care
| Published date | 01 March 2003 |
| DOI | https://doi.org/10.1108/13619322200300003 |
| Date | 01 March 2003 |
| Pages | 9-16 |
| Author | Penny West |
| Subject Matter | Health & social care |
Improving Mental Health
Inpatient Care
Penny West
Programme Manager (Acute Inpatient
Care)
Centre for Mental Services Development
England
Framework feature
Introduction
Acute inpatient care is and will remain a core element
of the mental health care system. Yet the quality of
care available is often seen by service users and carers,
as well as by staff who work within it, to be non-
therapeutic, institutional and isolated from other
mental health services. Guidance from the
Department of Health (2001) stated that there is
‘incontrovertible and compelling evidence,
particularly from service user feedback, that the
experience of acute inpatient care is felt to be neither
safe nor therapeutic’. It consumes over £800 million
per annum – about 25% of the mental health budget
and has many dedicated and hardworking staff. So
how did this situation arise?
Until recently the emphasis of post-war policy
makers, commissioners, managers and senior clinicians
had been on establishing community mental health
services as alternatives to hospital care. Five short
years ago mental health acute inpatient care seemed
barely on the national agenda. There was a growing
awareness that all was not well, but there was little
actual evidence about the nature of the problems and
even less about what the solutions might be to remedy
the situation. There seemed to be a widely held belief
that there might not be a need for inpatient care in the
future and that there was no need to give it much
attention; the focus was upon developing community,
non-institutional services. Yet now in 2003 mental
health acute inpatient care has risen sharply up the
agenda. There is clear recognition of the problems it
has been facing and increased understanding of the
new role it needs to play in the spectrum of mental
health care. There is a new sense of direction,
additional investment and a gradual improvement in
service user satisfaction and staff morale.
This paper explores the current challenges facing
inpatient care and outlines some of the exciting new
developments in the field. It looks at the historical
context; the emerging evidence of problems,
particularly service user and staff dissatisfaction; the
recognition of the need for change and outlines some
of the new initiatives that are beginning to have an
impact at ward level. There is now a growing sense
that inpatient care has indeed an important role to
play and that it is possible, even on busy wards, to
respond to the needs of services users and to concepts
of evidence-based practice. But the change to modern,
user-focused care, and the major cultural shift it
requires, will not be easy, cheap, or quick.
The historical context
‘Community care’ is not new. It is said to have arisen
from a speech given in 1961 by Enoch Powell, then
minister of health. In this speech he announced the
rundown and eventual closure of the large, remote,
Victorian ‘watertower’ institutional psychiatric
hospitals. In 1962 the Hospital Plan was published by
the Ministry of Health. It confirmed the change in
post-war policy from an institution-based approach to
one that emphasised alternative care in community
settings.
Community care was promoted on cost grounds as
well as humanitarian ones. According to the Audit
Commission (1986; 1994) many people currently in
psychiatric hospitals could be cared for at less than
half the cost in a non-institutional alternative setting.
The general view, at that time, seemed to be that costs
could be cut dramatically (Merson et al, 1996; Moore
& Wolf, 1999) if community alternatives were set up
adequately. However, it became increasingly evident
The Mental Health Review Volume 8 Issue 1 March 2003 ©Pavilion Publishing (Brighton) 2003 9
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