Rethinking acute inpatient care.

Significant opportunities now exist for the treatment and care of people with mental illness and a range of community facilities are often provided. However, the specific role of the psychiatric inpatient unit within a comprehensive mental health service continues to be a focus of debate. In England, the Department of Health's policy is that specialist psychiatric services should target their efforts toward severely mentally ill people to ensure that they receive the treatment, care and follow up that they need. The current use of beds by those with severe mental illness has recently been reviewed at the Bethlem Royal and Maudsley Hospitals by examining a sample of 1000 people admitted to six acute wards over a two year period. The results suggest that the majority of people are admitted to hospital appropriately. However, research on inpatient wards reveals that nurses are not coping effectively with the changing inpatient population. Patient care plans often reveal a lack of co-ordination and clinical focus. It is proposed that greater attention to the reasons for admission to hospital will highlight priorities for care, leading to more purposeful interventions and ultimately better use of resources.