Challenging Bed Behaviours: The use of Acute Psychiatric Beds in an Inner-London District Health Authority

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Abstract
The requirement for District Health Authorities to assess the health care needs of their population should lead them to consider how acute hospital care meets identified needs. This point prevalence study, conducted at four hospitals in an inner-London health district, enumerated the number of patients perceived by medical, nursing and social work staff as no longer requiring acute psychiatric facilities. Overall 227 patients were enumerated, and of these 85 (36.6%) were identified by at least one health care professional or social worker as no longer requiring specialist acute facilities. Where all health care professionals and social workers were interviewed regarding individual patients (111 of the 227 cases) doctors, nurses and social workers agreed on 12 (7%) inappropriately located patients. Over-represented in this group were female patients, those aged over 65 years and those whose hospital stay exceeded three months. Schizophrenia constituted the main diagnosis for all patients of all ages identified as no longer requiring specialist acute facilities. The main reasons advanced for patients' inappropriate location were the needs for more residential accommodation and long-stay hospital care. The inappropriate location of these patients illustrates failings of both the current health and social welfare systems and highlights the need to provide more appropriate services.