Meeting the accommodation needs of the most severely mentally ill

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Abstract
Despite a continued fall in total psychiatric bed numbers, there are more people aged 15 to 44 in psychiatric hospitals today than there were 10 years ago. The increase in hospital episodes is most pronounced in young men who account for over 40% more episodes than they did a decade ago. Very few hospital beds have been replaced by other residential provision in the community and there are now only one-third of the residential places (hospital or community) there were forty years ago. There is great pressure on psychiatric admission beds in some parts of the country and as a result these services are spending millions of pounds admitting people to distant hospitals as ‘extra-contractual' referrals. In London, one-third of in-patients on admission units, which are intended for short-stay, have been there for more than three months. In part this, and the over-occupancy of admission units, is due to difficulty in discharging people because suitable community-based residential provision is not available. One large group of patients who are difficult to discharge, from both short- and long-stay wards, are young men with severe mental illness and histories of violence. Existing high-staffed, community-based hostels, which have a low proportion of unqualified staff, appear to exclude people who pose risk of acting violently. The government's recently announced guidance that health authorities should commission 5,000 additional beds, in facilities staffed by nurses 24-hours a day, is the right policy. Unfortunately for the majority of services which have already completed their hospital closure programme, the funding for these places is unlikely to come from diverting resources from in-patient services.

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