RELATION BETWEEN BED USE, SOCIAL DEPRIVATION, AND OVERALL BED AVAILABILITY IN ACUTE ADULT PSYCHIATRIC UNITS, AND ALTERNATIVE RESIDENTIAL OPTIONS - A CROSS-SECTIONAL SURVEY, ONE-DAY CENSUS-DATA, AND STAFF INTERVIEWS

Objectives: To examine the relation between bed use, social deprivatio n, and overall bed availability in acute adult psychiatric units and t o explore the range of alternative residential options. Design: Cross sectional survey, combined with one day census data; ratings by and in terviews with staff; examination of routine data sources. Settings: Na tionally representative sample of acute psychiatric units. Subjects: 2 236 patients who were inpatients on census day. Main outcome measures: Bed occupancy levels, judged need for continuing inpatient care, reas ons preventing discharge, scores on the Health of the Nation outcome s cales. Results: Bed occupancy was related to social deprivation and to tal availability of acute beds (r=0.66, 95% confidence interval 0.19 t o 0.88, F=8.72, df=2, 23; P = 0.002). However, 27% (603/2215) of curre nt inpatients (61% (90/148) of those with stays of >6 months) were jud ged not to need continuing admission. The major reasons preventing dis charge were lack of suitable accommodation (31% (176/482) of patients in hospital <6 months v 36% (31/86) of those in hospital >6 months); i nadequate domiciliary based community support (23% (113) v 9% (8)); an d lack of long term rehabilitation places (21% (100) v 47% (40)). Scor es on the Health of the Nation outcome scale were generally consistent with these staff judgments. Conclusions: The shortage of beds in acut e psychiatric units is related to both social deprivation and the over all availability of acute beds. Patients currently inappropriately pla ced on acute admission wards should be relocated into more suitable ac commodation, either in hospital or in the community. A range of provis ions is required; simply providing more acute beds is not the answer.