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Acute psychiatric services: an appraisal of a major change in service delivery within one catchment area

Published online by Cambridge University Press:  13 June 2014

Miriam O'Doherty*
Affiliation:
St. Vincent's Hospital, Convent Avenue, Richmond Road, Fairview, Dublin 3, Ireland

Abstract

Objectives: To investigate effects on one psychiatric inpatient service of a 40% reduction in the number of acute beds and the establishment of an acute day hospital.

Method: A retrospective review of all public admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of attendance at the acute day hospital during the second study period.

Results: 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 brief 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 stay and the frequency of re-admission within 28 days of discharge changed little, while patients with diagnoses of mild/moderate depression and substance misuse experienced significantly shorter admissions and higher readmission rates. The use of temporary orders under the Mental Treatment 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 them required admission before and/or after attendance at the day hospital.

Conclusions: The major reduction in the number of acute inpatient beds and the opening of an acute day hospital resulted in greater concentration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in admissions and may have a complex aetiology and merits further investigation.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 1998

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References

Referances

1.Walsh, D. Mental health service models in Europe. In: Mental health services in pilot study areas: Report on a European Study. Copenhagen: WHO, 1987.Google Scholar
2.Department of Health, Dublin. The psychiatric services – planning for the future: report of a study group on the development of the psychiatric services. Dublin Stationery Office, 1984.Google Scholar
3.O'Doherty, M, Atakan, Z. Has practice made perfect?; use of the Mental Heath Act (1983) a decade after its introduction, (unpublished)Google Scholar
4.Pryce, IG. An expanding ‘stage army’ of long-stay psychiatric patients. Br J Psychiatry 1982; 141: 596601.CrossRefGoogle Scholar
5.Mc Grath, G, Tantam, D. Long-stay patients in a psychiatric day hospital. Br J Psychiatry 1987; 150: 836–40.CrossRefGoogle Scholar
6.Piatt, DP, Knights, AC, Hirsch, SR. Caution and conservatism in the use of a psychiatric day hospital: evidence from a research project that failed. Psychiatric Res 1980; 3: 123–32.Google Scholar
7.Bowman, EP, Shelley, RK, Sheehy-Skeffington, Aet al.Day patient versus inpatient care: factors determining selection of acutely ill patients for hospital treatment. Br J Psychiatry 1983; 142: 584–7.CrossRefGoogle ScholarPubMed
8.Hoult, J. Community care of the mentally ill. Br J Psychiatry 1986; 149: 137–44.CrossRefGoogle Scholar
9.Creed, F, Anthony, P, Godbert, K, Huxley, P. Treatment of severe psychiatric illness in a day hospital. Br J Psychiatry 1989; 154: 341–7.CrossRefGoogle Scholar
10.Creed, F, Black, D, Anthony, P. Day hospital and community treatment for acute psychiatric illness: a critical appraisal. Br J Psychiatry 1989; 154: 300–10.CrossRefGoogle ScholarPubMed
11.Creed, F, Black, D, Anthony, P, Osborn, M, Thomas, P, Tomenson, P. Randomised controlled trial of day patients versus inpatient psychiatric treatment. BMJ 1990; 300: 1033–7.CrossRefGoogle ScholarPubMed