Community care: does it reduce the need for psychiatric beds? A comparison of two different styles of service in three hospitals

Article Abstract:

As changes occur in the care of psychiatric patients in the UK, the number of inpatients in mental hospitals seems to be dropping. In an effort to cut costs, a shift in the site of treatment is occurring, from traditional psychiatric hospitals to psychiatric departments of general hospitals. To evaluate whether this community care-based approach is actually responsible for the decline in inpatients, a study was conducted of the admission records of three psychiatric treatment facilities in northern England: a general hospital psychiatric department (Kidderminster General Hospital); the traditional mental hospital which Kidderminster eventually replaced (Powick Hospital); and a traditional mental hospital in a neighboring area (Barnsley Hall). Admissions evaluations were confined to patients under 65. Various features of admission records were examined, including per capita admission rates, readmission rates, the numbers of patients admitted more than three times in a year, and various aspects of duration of stay. The only area in which any of the hospitals seemed to significantly differ statistically was in length of stay, both short-term and long-term: patients admitted to Barnsley Hall tend to stay in the hospital about twice as long as those admitted to Kidderminster or Powick (the latter two facilities had similar durations of stay). Kidderminster had substantially more admissions lasting a week or less. After various methodological problems are accounted for, the fact remains that the expansion of community services for the mentally ill has had very little impact upon the pattern of hospital bed use. This finding suggests that in a given community, there is a 'bed-rock' level of serious psychiatric illness that will always require inpatient care, and shifting from more traditional to more community-based care will not result in any significant cost advantages. (Consumer Summary produced by Reliance Medical Information, Inc.)

United Kingdom, Community psychiatric services, Community mental health services, Hospital outpatient services, Great Britain

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The Scottish survey of old long-stay in-patients

Article Abstract:

In order to evaluate the characteristics of patients who had been hospitalized before age 65 in Scotland, with a stay of at least six years in a psychiatric institution, 18 hospitals with a combined catchment population representing 83 percent of the total Scottish population were studied. The survey identified 2,605 long-term patients (59 per 100,000 of the general population). The majority were male (57 percent), single (75 percent), and over 60 years of age (70 percent). Forty-one percent had been hospitalized for over 30 years; 1 percent had been hospitalized for 60 years or more. Schizophrenia was the most common diagnosis, followed by organic brain disease, mental handicap, and manic-depressive psychosis. One of every five patients was randomly chosen and administered a mental state examination. Staff who knew the patients well rated their rehabilitation status and indicated how each patient could be best accommodated. Among the random sample (527 patients), 68 percent needed to remain in the hospital according to the rehabilitation teams. Twenty-two percent required staffed hostel lodgings, while another 8 percent either required a group home or sheltered lodgings. As in the larger group, schizophrenics comprised the primary diagnostic group: 59 percent were male, and 71 percent were over 60. Almost 50 percent had been hospitalized for 30 years or more. In sum, the average 'old long-stay patient' was male, single, over 60 years old, schizophrenic, and considered the hospital to be his home. If Scotland decides that some psychiatric institutions must be closed (as England has), discharging these patients without adequate out-patient support could prove disastrous. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Services, Demographic aspects, Hospital utilization, Psychiatric hospital patients

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What happens to patients who frequently harm themselves? (A retrospective one-year outcome study)

Article Abstract:

Since 1982, records of admission to the Regional Poisoning Treatment Centre (RPTC) in Edinburgh, Scotland have been computerized. Between 1982 and 1987, the average number of patients admitted to the RPTC each year for deliberate self-harm was 1,154. Forty-two of those patients had been admitted three or more times within the same week. Of those 42, only two were employed and all were from the lower socio-economic classes. Thirty-three had at least one known arrest conviction, and 18 had served at least one prison sentence. Thirty-two patients had repeatedly taken drug overdoses, and eight had cut their wrists at least once. The majority of episodes of self-harm were unexplained, although 32 patients had consumed alcohol before hurting themselves. Twenty-three were diagnosed with personality disorder. To describe clinical features and demographic characteristics of patients who frequently harm themselves, these 42 patients (23 men and 19 women with an average age of 29.5 years) were followed-up for one-year. Case notes from Edinburgh hospital and health-service clinics, as well as computerized national health service-registers provided follow-up data. By the end of the follow-up period, 36 patients had been readmitted to the RPTC; 34 had been readmitted within three months post-discharge. Fifteen had been re-convicted, and 10 served prison time. Only one patient was employed. In this sample, psychiatric hospitalization did not prevent repetitive self-harm. The lack of suicidal events was attributed to the young age of the patients and to the fact that no one in the sample was considered to be acutely mentally ill. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Mental illness, Mental disorders, Self-destructive behavior, Self injurious behavior, Edinburgh, Scotland

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