Use of acute psychiatric beds: a point prevalence survey in North and South Thames regions

BACKGROUND: Concerns have been expressed, particularly in inner cities, about the growing pressure on acute psychiatric beds, evidenced by increased occupancy rates, difficulties in accessing beds, and increasing use of private beds by health authorities. This study investigated these concerns by conducting a census of psychiatric patients occupying acute beds. The proportion of patients who no longer required acute care and their needs for alternative provision were determined, together with bed occupancy rates. METHODS: A point prevalence survey of acute psychiatric patients in all National Health Service acute psychiatric units and seven private psychiatric units in North and South Thames regions was conducted on 15 June 1994. Sociodemographic, diagnosis and admission characteristics data were collected. Patients who no longer required acute care were identified and the alternative service provision required for these patients was determined. Bed occupancy rates were calculated. RESULTS: A total of 3710 psychiatric patients (including those on leave) were ennumerated. More than one in five (23.2 per cent) were defined as inappropriately located. The main alternative services required for inappropriately located patients who could be discharged to the community were professional support in patient's home (71.5 per cent), and housing or more appropriate housing (61 per cent). For inappropriately located patients who could not be discharged into the community, the main alternative services required were group home (29.3 per cent) and in-patient rehabilitation (20.8 per cent). Bed occupancy rates were high on the day of the survey (95 per cent). CONCLUSION: Best use is not being made of acute psychiatric beds in the Thames regions. A high proportion of patients occupying beds are those who no longer require acute care, but for whom alternative services are unavailable.