Beds crisis impairs treatment of mentally ill: Snapshot survey of inner London services paints a grim picture. Celia Hall reports

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MENTALLY ILL patients in inner London are receiving inadequate care because of a shortage of acute psychiatric beds, according to the first snapshot survey of mental illness provision, published yesterday.

The Royal College of Psychiatrists report paints a grim picture of overcrowded wards where assaults occur daily, where some patients receive too much medication and where others are discharged too soon. The survey, Monitoring Inner London Mental Illness Services, says that on the day of the 'census' in 12 inner London mental illness services, there was a 30 per cent shortages of beds. The researchers say that 426 extra hospital places in a variety of forms are needed to overcome the crisis. There are currently 1,109 acute beds available in the survey area.

One reason for the pressure on beds is lack of suitable community hostel places and other less acute provision. As a result, admission beds become blocked. 'We are extremely concerned about standards of care for the mentally ill and although our survey was in inner London, other inner cities - Birmingham, Newcastle and Manchester - will face similar problems,' Dr Fiona Caldicott, president of the college, said.

Dr Paul Lelliott, director designate of the college's research unit, said that in the country overall since the 1950s two-thirds of psychiatric beds had closed and the proportion of spending devoted to mental health in the NHS had dropped from 15 per cent to 10 per cent. 'There is little evidence that the money freed up by the closures has been fed into care in the community,' he added.

In the absence of other data, the college decided to survey the state of mental illness admission wards on 15 June. Participating psychiatrists answered other questions about the two weeks either side of the date. They plan to monitor the service at six-monthly intervals.

The services covered a population of 2.6 million and 10 of the areas are in the list of the 17 most socially deprived areas of England. There were a total of 105 assaults, of which one was major, 37 involved minor bruises and cuts and 67 were lesser assaults that left no visible injury. There were 53 incidents of sexual harassment, including eight sexual assaults, of which six were in one district. Another 281 incidents were of verbal assault or damage to property but these were not reliable enough to be included in the data. The survey found that, in the census week, 204 patients needing admission to the specialist wards had to be lodged elsewhere. Of these, 53 went into non-admission wards in the same trust and five went into medical wards; 42 went to other NHS hospitals. Sixty patients were given beds in private psychiatric units, 30 went home or were housed in the community, and 14 kept in prison or police cells.

In addition, nine services said that 84 patients whom doctors thought needed to be admitted could not be because of the bed shortages and another 24 patients were discharged prematurely.

The report says that the high bed occupancy may be due to inappropriate admissions, inefficient clinical assessment and treatment leading to prolonged hospital stays, and inadequate community services. 'None of these findings will be news to those who work in inner London services but, for the first time, some of the problems can be quantified and monitored.'

David Blunkett, Labour's health spokesman, said: 'There has been a large reduction in inner London psychiatric beds without the promised alternative facilities provided in the community.'

He said that there was no sign either of promised legislation on supervised discharge. 'Nor is there any indication that there are any plans to introduce the round- the-clock crisis centres called for in the Mental Health Foundation report last week.'

Alan Langlands, chief executive of the NHS, said the report confirmed some of the Department of Health's own findings. However, it was too simplistic to say extra beds alone would solve the crisis.

(Photograph omitted)