INNER LONDON COLLABORATIVE AUDIT OF ADMISSION IN 2 HEALTH DISTRICTS .3. REASONS FOR ACUTE ADMISSION TO PSYCHIATRIC-WARDS

Background. In this series, rates of admission and daily bed use in so uth Southwark were 30% higher than in Hammersmith and Fulham, principa lly because of a higher rate of admission for affective disorders. Fac tors associated with compulsory admission did not differ between the d istricts. This final paper examines the severity of symptoms, the reas ons given for admission and factors relevant to the judgement to admit , in order to test the hypothesis that more resources mean better serv ice. Method. Sampling and data collection methods were described in th e first paper. Results. In both districts, major reasons for admission were self-neglect and risk of self-harm, poor adaptive functioning, a nd poor acceptance of medication. In south Southwark, a group of patie nts had affective disorders and less severe symptoms but a stated risk of suicide. Rates for, and severity of, schizophrenia were similar in the two districts. Social and preventive reasons for admission were g iven more frequently in south Southwark, where patients had more often been in contact with services before admission. Staff there, but not in Hammersmith and Fulham, suggested that many could have benefited fr om alternative forms of residential care. Conclusions. A 'buffer' of h ospital beds in south Southwark may have allowed a more acceptable ser vice, particularly for affective disorders. The possibility that this buffer could be replaced by a wider range of residential accommodation , including hostels away from the District General Hospital, is discus sed. Ten recommendations are listed.