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When should governments increase the supply of psychiatric beds?

Molecular Psychiatry volume 23, pages 796–800 (2018)Cite this article

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Abstract

Low numbers of hospital-based psychiatric beds create problems for people with severe mental illness (SMI), when they face extended emergency department (ED) waits, higher thresholds for admission to an acute bed, and short revolving-door stays with high rates of rehospitalisation. Limited access to inpatient treatment has been associated with higher suicide risk, premature mortality, homelessness, violent crime and incarceration. Ultimately, people with SMI can be transinstitutionalised to the criminal justice system. In the USA, for example, prisons have replaced mental hospitals as the largest institutions housing people with SMI. There is no international consensus on the safe minimum numbers of acute, forensic and rehabilitation beds needed to reduce these risks. As a consequence, Organisation for Economic Cooperation and Development (OECD) countries have wide variations in the mix of hospital beds with an average of 71 beds per 100 000 population. Policymakers face difficult choices with few studies to guide decisions on supplying beds. The UK Royal College of Psychiatrists offered a policy framework, which was adapted for Australia. The government of the State of South Australia increased the supplies of crisis, acute and forensic beds to meet a mandatory target to safely reduce mental health boarding in the EDs.

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References

  1. Organisation for Economic Cooperation and Development. OECD Health Statistics 2015. Available at http://stats.oecd.org/# (accessed 18 March 2016).

  2. Tyrer P, Sharfstein S, O’Reilly R, Allison S, Bastiampillai T . Psychiatric hospital beds: an Orwellian crisis. Lancet 2017; 389: 363.

    Article  PubMed  Google Scholar 

  3. Hewlett E, Moran V . Making Mental Health Count: The social and economic costs of neglecting mental health care. OECD Publishing: Paris, France, 2014.

    Book  Google Scholar 

  4. Organisation for Economic Cooperation and Development. Australia at the forefront of mental health care innovation but should remain attentive to population needs, says OECD. 2014. Available at http://www.oecd.org/els/health-systems/MMHCCountry-Press-Note-Australia.pdf (accessed 18 March 2017).

  5. Allison S, Bastiampillai T . Mental health services reach the tipping point in Australian acute hospitals. Med J Aust 2015; 203: 432–434.

    Article  PubMed  Google Scholar 

  6. Glick ID, Sharfstein SS, Schwartz HI . Inpatient psychiatric care in the 21st century: the need for reform. Psychiatr Serv 2011; 62: 206–209.

    Article  PubMed  Google Scholar 

  7. Tyrer P . Has the closure of psychiatric beds gone too far? Yes. BMJ 2011; 343: d7457.

    Article  PubMed  Google Scholar 

  8. Bastiampillai T, Sharfstein S, Allison S . Increase in US suicide rates and the critical decline in psychiatric beds. JAMA 2016; 316: 2591–2592.

    Article  PubMed  Google Scholar 

  9. Hunt IM, Rahman MS, While D, Windfuhr K, Shaw J, Appleby L et al. Safety of patients under the care of crisis resolution home treatment services in England: a retrospective analysis of suicide trends from 2003 to 2011. Lancet Psychiatry 2014; 1: 135–141.

    Article  PubMed  Google Scholar 

  10. Fazel S, Wolf A, Palm C, Lichtenstein P . Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. Lancet Psychiatry 2014; 1: 44–54.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Torrey EF, Zdanowicz MT, Kennard AD, Lamb HR, Eslinger DF, Biasotti MC et al. The Treatment of Persons with Mental Illness in Prisons and Jails: a State Survey. Treatment Advocacy Center: Arlington, USA, 2014.

    Google Scholar 

  12. Munk-Jørgensen P . Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci 1999; 249: 136–143.

    Article  PubMed  Google Scholar 

  13. Ösby U, Correia N, Brandt L, Ekbom A, Sparén P . Time trends in schizophrenia mortality in Stockholm county, Sweden: cohort study. BMJ 2000; 321: 483–484.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pirkola S, Sohlman B, Heila H, Wahlbeck K . Reductions in postdischarge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland. Psychiatr Serv 2007; 58: 2221–2226.

    Article  Google Scholar 

  15. Lumme S, Pirkola S, Manderbacka, Keskimaki I . Excess mortality in patients with severe mental disorders in 1996-2010 in Finland. PLoS ONE 2016; 11: e0152223.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thornicroft G, Tansella M . The balanced care model: the case for both hospital- and community-based mental healthcare. Br J Psychiatry 2013; 202: 246–248.

    Article  PubMed  Google Scholar 

  17. Organisation for Economic Cooperation and Development. Japan trails other countries in ‘deinstitutionalisation’, but there are signs of progress, says OECD. 2014. Available at https://www.oecd.org/els/health-systems/MMHC-Country-Press-Note-Japan.pdf (accessed 18 March 2017).

  18. Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M . Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 2007; 335: 336.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Keown P, Weich S, Bhui KS, Scott J . Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study. BMJ 2011; 343: d3736.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crisp N, Smith G, Nicholson K (Eds.) Old Problems, New Solutions: Improving Acute Psychiatric Care for Adults in England. The Commission on Acute Adult Psychiatric Care. Royal College of Psychiatrists: London, UK, 2016.

    Google Scholar 

  21. Kim D . Psychiatric deinstitutionalization and prison population growth: a critical literature review and its implications. Crim Justice Policy Rev 2016; 27: 3–21.

    Article  Google Scholar 

  22. Penrose LS . Mental disease and crime: outline of a comparative study of Europeam statsitics. Br J Med Psychol 1939; 18: 1–15.

    Article  Google Scholar 

  23. Mundt AP, Chow WS, Arduino M, Barrionuevo H, Fritsch R, Girala N et al. Psychiatric hospital beds and prison populations in South America since 1990: does the Penrose hypothesis apply? JAMA Psychiatry 2015; 72: 112–118.

    Article  PubMed  Google Scholar 

  24. Kelly M . Inequality and crime. Rev Econ Stat 2000; 82: 530–539.

    Article  Google Scholar 

  25. Organisation for Economic Cooperation and Development. Income inequality remains high in the face of weak recovery. 2016. Available at http://www.oecd.org/social/inequality-and-poverty.htm (accessed 18 March 2017).

  26. Lamb HR, Bachrach LL . Some perspectives on deinstitutionalization. Psychiatr Serv 2001; 52: 1039–1045.

    Article  CAS  PubMed  Google Scholar 

  27. Walmsley R . World Prison Population List. Institute for Criminal Policy Research. University of London: Birkbeck, Available at http://www.prisonstudies.org/research-publications (accessed 4 April 2017).

  28. Torrey EF, Kennard AD, Eslinger D, Lamb R, Pavle J . More Mentally Ill Persons are in Jails and Prisons than Hospitals: a Survey of the States. Treatment Advocacy Center: Arlington, USA, 2010.

    Google Scholar 

  29. Sisti DA, Segal AG, Emanuel EJ . Improving long-term psychiatric care: bring back the asylum. JAMA 2015; 313: 243–244.

    Article  PubMed  Google Scholar 

  30. Fuller DA, Sinclair E, Geller J, Quanbeck C, Snook J . Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds. Treatment Advocacy Center: Arlington, USA, 2016.

    Google Scholar 

  31. Capp JD, Grubaugh AL, Allen JG, Mahoney J, Oldham JM, Fowler JC et al. Modelling trajectory of depressive symptoms among psychiatric inpatients: A latent growth curve approach. J Clin Psychiatry 2013; 74: 492–499.

    Article  Google Scholar 

  32. Allison S, Bastiampillai T, Fuller DA, Gupta A, Chan S . The Royal Australian and New Zealand College of Psychiatrists guidelines: acute inpatient care for schizophrenia. Aust NZP Psychiatry 51: 191–192.

    Article  Google Scholar 

  33. Sherwood M, Thornton AE, Honer WG . A meta-analysis of profile and time-course of symptom change in acute schizophrenia treated with atypical antipsychotics. Int J Neuropsychopharmacol 2006; 9: 357–366.

    Article  PubMed  Google Scholar 

  34. Agid O, Kapur S, Arenovich T, Zipursky RB . Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Arch Gen Psychiatry 2003; 60: 1228–1235.

    Article  CAS  PubMed  Google Scholar 

  35. Suzuki T, Remington G, Arenovich T, Uchida H, Agid O, Graff-Guerrero A et al. Time course of improvement with antipsychotic medication in treatment-resistant schizophrenia. Br J Psychiatry 2011; 199: 275–280.

    Article  PubMed  Google Scholar 

  36. Kudlow PA, McIntyre RS, Lam RW . Early switching strategies in antidepressant non-responders: current evidence and future research directions. CNS Drugs 2014; 28: 601–609.

    Article  CAS  PubMed  Google Scholar 

  37. Stassen HH, Angst J, Hell D, Scharfetter C, Szegedi A . Is there a common resilience mechanism underlying antidepressant drug response? Evidence from 2848 patients. J Clin Psychiatry 2007; 68: 1195–1205.

    Article  CAS  PubMed  Google Scholar 

  38. Lam RW . Onset, time course and trajectories of improvement with antidepressants. Eur Neuropharmacol 2012; 22: S492–S498.

    Article  CAS  Google Scholar 

  39. Bowden CL, Brugger AM, Swann AC et al. Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 1994; 271: 918–924.

    Article  CAS  PubMed  Google Scholar 

  40. Elixerhauser A, Steiner C . Statistical Brief #153: Readmissions to US Hospitals by Diagnosis, 2010. Agency for Healthcare Research and Quality: Rockville, USA, 2013.

    Google Scholar 

  41. Fitch WL . Assessment #3: Forensic Mental Health Services in the United States. National Association of State Mental Health Program Directors: Alexandria, Virginia, USA, 2014.

    Google Scholar 

  42. Fuller DA, Sinclair EA, Lamb HR, Cayce JD, Snook J . Emptying the ‘new asylums’: a beds capacity model to reduce mental illness behind bars. The Treatment Advocacy Center: Arlington, USA, 2017.

    Google Scholar 

  43. Millard C, Wessely S . Parity of esteem between mental and physical health. BMJ 2014; 349: g6821.

    Article  PubMed  Google Scholar 

  44. Saha S, Chant D, McGrath J . A systematic review of mortality in schizophreniais the differential mortality gap worsening over time? Arch Gen Psychiatry 2007; 64: 1123–1131.

    Article  PubMed  Google Scholar 

  45. Royal College of Psychiatrists Do the Right Thing: How to Judge a Good Ward. Ten Standards for Adult in-Patient Mental Healthcare. Royal College of Psychiatrists: London, UK,, 2011.

  46. Torrey EF, Entsminger K, Geller J, Stanley J, Jaffe DJ . The Shortage of Public Hospital Beds for Mentally Ill Persons. The Treatment Advocacy Center: Arlington, USA, 2008.

    Google Scholar 

  47. Allison S, Bastiampillai T, Goldney R . Acute versus sub-acute care beds: Should Australia invest in community beds at the expense of hospital beds? Aust N Z J Psychiatry 2014; 48: 952–954.

    Article  PubMed  Google Scholar 

  48. Australian Institute of Health and Welfare, Australian Government. Specialised mental health beds and patient days. Available at https://mhsa.aihw.gov.au/resources/facilities/beds/ (accessed 21 March 2017).

  49. Siebert B . Mental health ED wait times lowest in a decade: SA Health. Available at http://indaily.com.au/news/local/2017/03/24/mental-health-ed-wait-times-lowest-in-a-decade-sa-health/ (accessed 21 March 2017).

  50. McKinsey and Company. SA Health Senior Management Forum: Mental Health. Available at https://www.anmfsa.org.au (accessed 21 March 2017).

  51. Carers Victoria. Response to KPMG and Department of Health and Human Services ‘Victoria’s Clinical Mental Health System Plan’ Discussion Paper: Design Service and Infrastructure Plan for Victoria’s Clinical Mental Health System. Available at http://www.carersvictoria.org.au/publications/policy-submissions (accessed 21 March 2017).

  52. Coroner’s Court of South Australia. Finding of Inquest: Renato Dooma. South Australian Government: Adelaide, Australia, 2006.

  53. Coroner’s Court of Victoria. Finding into Death with Inquest: Domenico Chiodo. Victorian Government: Melbourne, Australia, 2013.

  54. Australian Bureau of Statistics. Suicide in Australia. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Intentional%20self-harm:%20key%20characteristics~8 (accessed 21 March 2017).

  55. Allison S, Bastiampillai T, Siskind D, Reoger L, Goldney R . The National Mental Health Commission Report: Evidence based or ideologically driven? Aust N Z J Psychiatry 2015; 49: 960–962.

    Article  PubMed  Google Scholar 

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Acknowledgements

Author contributions

All authors contributed to concept development. The lead author wrote the first draft, and all authors were responsible for revising the correspondence.

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Authors and Affiliations

  1. Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia,

    S Allison, T Bastiampillai & J Licinio

  2. Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia,

    T Bastiampillai

  3. Department of Health, Executive Director Mental Health Strategy, Adelaide, SA, Australia,

    T Bastiampillai

  4. Head, Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia,

    J Licinio

  5. Project 5-100, South Ural State University Biomedical School, Chelyabinsk, Russian Federation

    J Licinio

  6. Treatment Advocacy Center, Arlington, VA, USA

    D A Fuller

  7. Department of Personal Health Informatics, School of Medicine, Flinders University, Adelaide, SA, Australia,

    N Bidargaddi

  8. President Emeritus, Shepherd Pratt Health System, Baltimore, MD, USA,

    S S Sharfstein

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  1. S Allison
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Correspondence to S Allison.

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Allison, S., Bastiampillai, T., Licinio, J. et al. When should governments increase the supply of psychiatric beds?. Mol Psychiatry 23, 796–800 (2018). https://doi.org/10.1038/mp.2017.139

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