ACUTE PSYCHIATRIC-SERVICES - AN APPRAISAL OF A MAJOR CHANGE IN-SERVICE DELIVERY WITHIN ONE CATCHMENT-AREA

Objectives: To investigate effects on one psychiatric inpatient servic e of a 40% reduction in the number of acute beds and the establishment of an acute day hospital. Method: A retrospective review of all publi c admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of at tendance at the acute day hospital during the second study period. Res ults: The number of admissions actually increased by 3% from 169-174; the mean duration of stay fell from 27-17 days; and the number of brie f admissions of three days duration or less almost tripled from 15-43. Although fewer patients suffering from schizophrenia were admitted in the second study period than in the first, their mean duration of sta y and the frequency of re-admission within 28 days of discharge change d little, while patients with diagnoses of mild/moderate depression an d substance misuse experienced significantly shorter admissions and hi gher readmission rates. The use of temporary orders under the Mental T reatment Act (1945) doubled, and the readmission rates within 28 days increased by over 60%. The acute day hospital treated 98 patients who had a diagnostic profile similar to that of the inpatients; 53% of the m required admission before and/or after attendance at the day hospita l. Conclusions: The major reduction in the number of acute inpatient b eds and the opening of an acute day hospital resulted in greater conce ntration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in ad missions and may have a complex aetiology and merits further investiga tion.