A report into the number of acute psychiatric beds in the Eastern Health Board area has found there are enough beds, but it highlights serious shortcomings in other areas of the service. While there was an adequate number of acute psychiatric beds, almost half of them were being occupied by non-acute patients. The report, carried out by the Health Research Board, found that some 91,000 bed-days were taken up through "inappropriate occupancy" throughout the year.
This has led to what the authors of the report, Dr Fiona Keogh, Ms Anne Roche and Dr Dermot Walsh, described as the undesirable practice of "borrowing beds" between the health services, resulting in the transfer of patients, often at short notice, from one service to another. "Such practices seriously compromise the quality of care," it stated.
The report also found that the high level of inappropriate occupancy was largely due to a lack of some services and the inadequate provision of others such as community residential accommodation.
In some cases rehabilitation places did not exist, and there was a serious shortage of community-based continuing care residential places. "There was, in general, a lack of a systematised spectrum of provision through the rehabilitation unit through community residential placement across the continuum of support, i.e. from hospital ward to high support, medium and low support community-based residential accommodation," it stated.
Community-based emergency 24-hour, seven-day-a-week crisis intervention services were generally found to be unavailable, the report pointed out.
The report, "We have no Beds", was commissioned by the Department of Health and Children in response to concerns about the availability of acute psychiatric beds in the EHB area. It recommended that resources be concentrated on providing additional community residential places and community-based mental health centres. This would contribute significantly to improving the quality of care available to patients who require longer-term accommodation appropriate to their needs, it said.
A shortage of day hospital places and a difficulty in defining the function of existing day hospitals was also found. "They seemed in some cases not to provide care for the more seriously ill patients and so, as far as these patients were concerned, were not operating as alternatives to acute inpatient care."
Community-based mental health services were "inadequately and unequally distributed" throughout the catchment area and, even where they were in place, it said, assessment of patients, particularly in relation to possible inpatient care or its alternatives, was rarely carried out there. "As a result many patients presented to the inpatient unit for assessment, thus making inappropriate admissions more likely."
The results of the study revealed that there were 558 acute adult psychiatric beds in use at the time of the census. Proper bed occupancy was 98 per cent, with seven of the 11 hospitals and units reporting occupancy rates of 100 per cent or more. "A striking finding was that close to half of the census patients were judged not to require the acute bed they were occupying."