Psychiatric inpatient care: where do we go from here?

Abstract

The significant decline in the number of psychiatric hospital beds for more than two decades across Europe has changed the landscape of mental health services. This has rekindled debates about bed shortages and the reasons for variations in the number of inpatient beds, admissions to hospital and length of stay. Analysis of European Union (EU) level data shows that the UK has a relatively low number of admissions to hospital, yet a much higher than average length of stay compared with 12 other EU Member States. Understanding this is difficult, but recent studies shed some further light on the patterns and predictors of admissions and length of stay.

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009–2018

“…In Canada, in the years from 2005 to 2015 patients diagnosed with schizophrenia spectrum disorders were hospitalized for an average of 97 days [40]. According to the WHO data [41], the longest lengths of hospitalization of schizophrenia patients were reported in the United Kingdom (132 days on average), the Czech Republic (89 days), Finland (71 days), and Poland (45 days), while the shortest lengths of stay were recorded in Denmark (6 days). In a study conducted in France, Germany and the United Kingdom, the length of hospitalization ranged from 39 to 57 days [27].…”

Shorter hospitalizations at the expense of quality? Experiences of inpatient psychiatry in the post‐institutional era

“…It seems obvious that longer‐term residential care is needed for the complex more disabled patients that are clogging acute care, but in the decades following the closure of the asylums, the UK also quietly disinvested in longer‐term care, so that there are now fewer rehabilitation beds per capita than elsewhere in Europe. At one point it was even a matter of policy that the new assertive community services would enable all psychiatric rehabilitation beds to close, and around half of the community rehabilitation teams were wound up, the staff being re‐tasked to provide for the home treatment and other new community teams.…”

From the 16th to the 21st Century: how we approach mental health problems and where do we go next?

“…Samele and Urquia, in the second Editorial, move the discussion on service provision to the next level, provocatively asking what is the future of psychiatric inpatient care, in view of the continuous decline in the number of hospital beds that has taken place across European countries (EU) (Samele & Urquia, 2015). These are the countries that, one would assume, share a similar vision of mental health disorders.…”