Forbes et al Reference Forbes, Cash and Lawrie1 found that the absolute number of compulsory admissions increased after the introduction of an intensive home treatment team and a reduction in hospital beds. Tyrer et al Reference Tyrer, Gordon, Nourmand, Lawrence, Curran and Southgate2 also described an increase in compulsory admissions after the introduction of home treatment teams. These findings raise concerns about the current policy of gatekeeping home treatment teams.
Looking at our own data, in the London borough of Wandsworth there were 151 compulsory admissions in the second quarter of 2008-2009, 119 compulsory admissions in the third quarter and 144 in the fourth quarter. In March 2009, there was a reduction of 6 in-patient beds, and in the first quarter of 2009-2010 there were 181 compulsorily admitted patients, which dropped to 151 in the second quarter and dropped again to 126 in the third quarter. The closure of 6 beds might well explain the increase in compulsory admissions in the first quarter of 2009-2010, but after 3 months the number of compulsory admissions dropped to the previous level.
A temporary increase in compulsory admissions after a reduction in hospital beds and the introduction of a home treatment team should be avoided if possible, but the consequences for service planning are far less severe than with a more permanent increase in involuntary admissions. Maybe with a larger reduction of in-patient beds the number of compulsory admissions would return to previous levels after a longer time period had passed.
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