Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: A cross sectional survey, one day census data, and staff interviews

Objectives: To examine the relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units and to explore the range of alternative residential options. Design: Cross sectional survey, combined with one day census data; ratings by and interviews with staff; examination of routine data sources. Settings: Nationally representative sample of acute psychiatric units. Subjects: 2236 patients who were inpatients on census day. Main outcome measures: Bed occupancy levels, judged need for continuing inpatient care, reasons preventing discharge, scores on the Health of the Nation outcome scales. Results: Bed occupancy was related to social deprivation and total availability of acute beds (r=0.66, 95% confidence interval 0.19 to 0.88, F=8.72, df=2, 23; P = 0.002). However, 27% (603/2215) of current inpatients (61% (90/148) of those with stays of >6 months) were judged not to need continuing admission. The major reasons preventing discharge were lack of suitable accommodation (31% (176/482) of patients in hospital <6 months v 36% (31/86) of those in hospital >6 months); inadequate domiciliary based community support (23% (113) v 9% (8)); and lack of long term rehabilitation places (21% (100) v 47% (40)). Scores on the Health of the Nation outcome scale were generally consistent with these staff judgments. Conclusions: The shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds. Patients currently inappropriately placed on acute admission wards should be relocated into more suitable accommodation, either in hospital or in the community. A range of provisions is required; simply providing more acute beds is not the answer.