Psychiatrists 'on the edge' as care crisis worsens

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"A state of deep crisis", "intolerable risk", "working on the edge". This is how psychiatrists describe care in the community in Britain.

Last week Professor Chris Thompson, registrar of the Royal College of Psychiatrists, spoke of "an upsurge of years of frustration" when its AGM overwhelmingly supported a resolution severely criticising the shortage of acute beds for the mentally ill.

It was only the third time in 25 years that such a resolution had been passed. The previous two had condemned foreign governments.

A conference of senior psychiatrists in London last week highlighted the difficulties they faced. Jeremy Coid, Professor of forensic psychiatry at St Bartholomew's, London, described the present system as a "great trundling wheel rolling in the wrong direction". Dr Trevor Turner, a consultant psychiatrist at Bart's and Homerton hospital, east London, said simply that care in the community was an "oxymoron".

The number of hospital beds for the mentally ill has steadily declined since 1957 when there were more than 140,000. Now there are just over 40,000.

Prof Thompson said almost every acute ward in the country had occupancy levels of more than 100 per cent and in London it could reach 140 per cent. The result is the "revolving door" syndrome where patients are discharged early only to return. "The revolving door is spinning faster and faster," said Prof Coid.

Emergency admissions are becoming the norm. Last month the Department of Health revealed a spectacular rise in the number of patients detained under the Mental Health Act because they are a danger to themselves or others. In the five years to 1994-5 the number admitted rose 55 per cent to 27,100. Voluntary admissions also rose 29 per cent.

"You're constantly working on the edge," he said. "But the pressure on beds means there is pressure to discharge people as soon as they're better. Some of our nurses say as soon as patients can talk to them they have to be discharged."

Faced with this situation, recruitment has become difficult. Dr Mike Harris, medical director of the independent Northampton hospital St Andrews, estimated that in some areas as many as one in five consultancy posts are going unfilled.

While the RCP endorsed new measures in February by the Secretary of State for Health, Stephen Dorrell, it feels it is not enough. The resolution called for a moratorium on bed closures, an inspectorate to oversee trained staff in community-based developments and districts in England and Wales to produce a plan for comprehensive mental health care to be implemented within three years. Otherwise, the profession feels, Dr Turner's account of "working on the edge" will continue. "The state that psychiatrists find themselves in is like asking a surgeon to operate using a rusty scalpel," Prof Thompson concluded.