7 - Inpatient treatment in the era of community psychiatry

Summary

Twenty years of rapid and continuing change in mental health services have brought us to the point where, in the UK and in many other countries, we are unequivocally in the era of community psychiatry. The provision of treatment in, or close to, the patient's home is the dominant model of practice, with empirical evidence to support its advantages and a balance of opinion that suggests it is preferred by service users (e.g. Dean et al., 1993; Burns et al., 2001). However, inpatient care shows no sign of disappearing. The historical trend in the UK for national bed numbers to drop has reversed. This has gone largely unnoticed, as the new beds (which now represent over fifty percent of the total) are in a new state-funded private sector (Ryan et al., 2007). For various reasons, including high cost, inpatient treatment continues to attract concern, but little attention has been paid to admission as a necessary part of some people's treatment.

Generally speaking, most psychiatrists are discernibly either enthusiasts or skeptics with regard to new models of care. This climate of opinion tends to obscure the question of the location of care as an important component to every strategic treatment plan. It is hard to find an appropriate role for inpatient stays as part of a coherent treatment strategy if one is preoccupied with either keeping patients out of hospital at all costs or trying to overcome barriers to admission.