Looking for beds

The new president of the Royal College of Psychiatrists, Professor Dinesh Bhugra, will according to the Guardian use his inaugural speech to lament the problems caused by the shortage of acute psychiatric beds in the system.

This is something we hear a lot about, and indeed, something described on There and Back Again’s blog about waiting for a hospital bed as an inpatient on leave when the ward is running a 150% occupancy rate recently.

Hospital beds in the hospital empty chamber. Kharkov, Ukraine.



Image via Wikipedia

Bhugra suggests that

No ward should ever be more than 80 per cent full if patients are to be safe, properly treated and cared for.

and while the sense of this can be obvious, it is rarely, if ever, the case in practice – or certainly isn’t in my own, admittedly limited, experience.

So something has to be done and Bhugra has a suggestion

‘ (Bhugra)..  is calling on the government to introduce a compulsory kitemark system of accreditation for all acute, inpatient psychiatric wards: ‘Until there is a compulsory kitemarking scheme, my prediction is that, as overcrowding increases, funding becomes more stretched and morale of patients and staff fall, overall conditions are likely to continue to deteriorate.’

Interesting. I know I rant against target-based practice but in can work in some areas. Perhaps if Trusts are told that funding will be cut or increased on the basis of their ability to find these beds – or that the levels of occupancy will be monitored by the Mental Health Act Commission and there will be financial penalties for applying poor standards – there will be more incentives to hospital managers to actually work on a solution – which doesn’t seem to be being done at the moment.

This Kitemark would measure against other standards such as staffing ratios as well and, indeed, in another article in the Guardian which focuses on current inpatient care, a spokesman for MIND says

‘A compulsory kitemark is a fantastic idea; these wards slip under people’s radar and that’s dangerous,’ she added. ‘When patients are sectioned, they literally have no choice at all about where they go. This makes it vitally important for society to be 100 per cent aware if these vulnerable people are ending up in wards where conditions don’t meet the minimum acceptable standards.’

Beds have been reduced as the focus has been on community care but the fact remains that some people need inpatient care and there isn’t always a reasonable substitute.

And with the incoming President of the Royal College of Psychiatrists in stating that

‘Acute psychiatric wards are now so poor, he (Bhugra) has admitted in an exclusive interview on the eve of his appointment, that he would not use them himself – nor allow a member of his family to do so.’

That is, perhaps, the saddest indictment of all.

Its pleasing that at least the situation is getting some more attention and will get even more when Bhugra actually makes his speech on Wednesday but one of the criteria that I have consistently tried to work on when considering placements for residential care is ‘would I be prepared for a close family member of mine to go to that home?’ and if the answer is no, I at least look for alternatives as I won’t use a home that I wouldn’t be prepared for a family member of mine to go to – or at least without offering the families and prospective residents an alternative option (which isn’t always taken or perfect for other reasons, like location but that’s another discussion for another day)

However as far as psychiatric wards go, that’s another matter.

Running acute wards at a 100% + occupancy doesn’t do anyone any favours in the long run and can lead to possibly longer or more frequent inpatient stays.

Where I work, I am fortunate in that I have a lot of faith in the psychiatric wards I normally use when people I work with are admitted.

Certainly on the over 65s wards where I know the staff much better, I can confidently say, I would be happy to spend time on those wards and would, without doubt, be happy for my father (only close family member I have that is over 65!) to go there. Because I know the wards are well-managed by an excellent nursing and medical team.

The other wards in the hospital, that I’ve had a bit less interaction with, have given me at least some faith in my interaction and observations of the interactions between patients and nursing and medical staff. I do know that this hospital is perhaps ‘one of the better’ ones.

Until I was on my placement in a different borough in my ASW course, my current hospital was the only psychiatric hospital I’d been to – I know that people had said it was a pleasant enough hospital but I didn’t know what to compare it to.

On placement I assessed and organised  an admission for a patient to a hospital I had heard about but never been to. We arrived. I was genuinely shocked myself about the look and feel of the ward. She was taken to her room and I honestly didn’t realise that there were wards like that around still. I think and have thought about it a lot. It has to change.

And the more publicity and public attention that is focused on the quality and care that is provided on some (but by no means all) of the psychiatric wards, the more hope that there will be for some change.

As for the running at over-capacity – the only solution in my own, simplistic mind, is more beds which means more money. Not very popular, I fear.

7 thoughts on “Looking for beds

  1. I was sectioned and spent a month on an acute psychiatric ward – when I was discharged and I spoke to the Psychiatrist who sectioned me about it, he apologised saying it was the only option he had. I can remember only one vaguely therapeutic exchange whilst an inpatient there, I lived on bread and jam, was told to go to bed so I didn’t inconvenence the staff and wasn’t allowed to take a shower after 8.30pm (no one could tell me why it just wasn’t allowed! And the coffee was foul!

  2. Sue, thanks for sharing that. In some ways, I think if the in-patient stay is simply about containment and not therapeutic intervention and recovery, it is no better than a prison and in some ways a lot worse. That really does sound awful.
    And although I’m not terribly surprised by that, Deb, I am disappointed. I wonder why it is that psychiatric wards are able to be so much worse than some of the surgical or medical wards (although I have to say, in the hospital where I am, I’d actually much rather be on the psychiatric ward – but I accept that that seems to be an exception).
    Hopefully, for us in the UK anyway, some more attention and focus on this situation will lead to an improvement.
    I wonder if its a throwback from the age of asylums.. the wider public doesn’t have as much interest in the state of inpatient psychiatric care as they do about other wards.

  3. Maybe it’s also because there’s still a lot of fear around mental health issues in the public arena, due to a lack of open debate and information. Fear is almost always based on lack of knowledge, which fuels a lack of interest which means the spot light isn’t turned on these issues like it is in more ‘publicly acceptable’ forms of health care?
    Plus general apathy I suppose.

  4. I think you’re right, Chuckle. If there were more interest or knowledge in the general public (although the figures suggest that most people have or know someone with a mental illness) would lead to faster action.
    And some of the newspaper reporting around mental illness doesn’t really help to quash any of the fears.

  5. I think the 150% etc bed occupancy rate does lead to longer inpatient stays and repeated admissions. People are not able to go home for a night and ‘test the water’ anymore before then trying a weekend etc because their bed won’t be there when they return the next day. So people just ‘go’ and it’s too big a jump for some, even with the support of the CRHT, who are supposed to be the stop-gap for the reduction in inpatient beds. I agree with you too on, that for some patients, inpatient care is needed despite the provision of CRHTs and so shouldn’t be ruled out in favour of community care.

    When I was first sectioned in 2002, everyone who was well enough went home for the weekend and we all returned on a Sunday night knowing our bed would still be there; you just can’t do that now. I have fond memories of those days, there was a strong sense of community and camaraderie – that’s not so much the case now and it’s quite sad.

    I read the article on the Guardian website when it was published and while I was nodding my head in agreement with the issues of bed occupancy I found myself sticking up for the actual state and care I receive on my acute ward. It’s excellent – it’s purpose built, and yes there are problems, but it’s a very nice environment. The nursing care and support is excellent. I feel compelled to speak up for them all!!!

    Thanks for the blog mention by the way!

  6. I was reading those Guardian articles in the context of having read your blog post, T&B so it was a natural follow on!
    I’m glad the care you’re getting is good. As I said, the ward that I usually work with is also what I would consider to be excellent and certainly the nursing staff as great.

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