Lack of community care means patients well enough for discharge remain in hospital too long

Embargoed until 30 July 2009

Up to a fifth of beds on Northern Ireland’s adult acute psychiatric wards are taken up by people well enough to be discharged, but who are being kept in hospital for up to a year because there is no appropriate care and accommodation available in the community, according to a survey by the Royal College of Psychiatrists.

The survey, which is part of the College’s FAIR DEAL campaign, found that many wards were running at above capacity, and in some cases foldaway beds are put up to add temporary capacity.

Psychiatrists and Ward Managers throughout Northern Ireland were asked about ward occupancy levels, the ward environment, and therapeutic input on wards. The survey found that the ward environment was generally reported to be satisfactory. While Occupational Therapy was widely available, there is very little availability of psychological therapies. Patients and carers in particular complained about this.

Most psychiatrists responded that there are rarely available beds on wards, and that people often need to be sent to hospitals outside their own area.

Dr Philip McGarry, Chair of the Royal College of Psychiatrists Northern Ireland Division, said the problem is not that there are not enough acute psychiatric beds in Northern Ireland, but reflects a lack of services for people with chronic and complex mental health problems.

“Psychiatrists are frustrated that we are having to keep people in hospital who don’t need to be there, and yet may have to send one of our own patients to a hospital in another area,” he said. “Overcrowded wards are not acceptable environments for patients, or for staff, and can affect not only a patient’s privacy and dignity, but also the care they get.

“The problem is made worse in that while there are targets for ensuring that more people at the mild to moderate end of mental health problems receive treatment within a reasonable time frame, there are no targets for services for people who have chronic mental illness that requires more intensive care.

“We are not against restructuring hospital beds, but before this happens there must be good community services. This includes not only various levels of housing and supported accommodation, but also weekend and out of hours centres for people to visit, Assertive Outreach teams that will ensure a person receives care, and more Home Treatment teams,” Dr McGarry said.

Further Survey Findings

• Both Patients/Carers and Staff complained that there is too little time for staff to spend with patients
• Patients/Carers reported that there should be more activities on wards
• While Staff reported that advocacy is widely available, Patients/Carers were unaware of this
• Both Staff and Patients/Carers reported good access to Occupational Therapy
• Staff reported that Social Work services are widely available on wards, but patients were unaware of this
• Three quarters of wards surveyed now have separate male and female areas

Background

There are 25 Adult Acute Admission wards in Northern Ireland, with in excess of 400 beds. (The exact number of beds is unclear due to current restructuring of wards.)

A high or excessive rate of bed occupancy brings risks to patients and others because services are unable to admit patients in an emergency and may discharge others prematurely in order to create an available bed. It can prevent the opportunity to discharge patients on short-term leave.

Consequent overcrowding can compromise the safety, dignity and privacy of patients and their clinical treatment. Being moved between beds, wards or even hospitals because of over-occupancy clearly disrupts a patient’s care. Staff may find that the demands of bed management divert them from their primary nursing role. The Mental Health Act Commission in England found that the frustration and stress experienced by staff in over-occupied wards was harmful to staff morale, and that this had an indirect effect on the quality of patients’ experience on the ward.

FAIR DEAL

FAIR DEAL is the Royal College of Psychiatrists’ 3 year campaign, founded on the views of psychiatrists, and our networks of service users and carers covering eight priority areas linked by the common theme of working towards equality for people with mental health problems:

• Funding
• Access to Services
• In-patient Services
• Recovery
• Discrimination and Stigma
• Engagement with service users/carers
• Availability of psychological therapies
• Linking mental and physical health

More information on FAIR DEAL is available at www.rcpsych.ac.uk/fairdeal

Note to editors:

The Royal College of Psychiatrists provides supervision of the training and accreditation of psychiatrists in Britain and Ireland, and provides guidelines and advice regarding the treatment, care and prevention of mental and behavioural disorders. Consultant psychiatrists lead multidisciplinary teams that are at the heart of mental health services in every locality in Northern Ireland.