Acute hospital care in inner London: splitting from mental health services in the community

Acute hospital care in psychiatry has been described as inefficient and disorganised (Muijen, 1999). Worrying as it may be, this is neither new nor surprising. Following the closure of large mental institutions and the advent of community care, hospital services were supposed to provide acute in-patient care as part of a wider system. Long-term needs of patients in the community should henceforth be met by community services that would be fully equipped and resourced to undertake this task. However, it was not long before acute wards were overwhelmed by occupancy rates of 100% and above, particularly in inner cites (Powell et al, 1995). The reason for the ‘bed crisis' that followed seems essentially twofold: community services were neither equipped nor resourced as required, and the number of acute beds was not adjusted to the ensuing demand. As hospital care has come to represent the only option for many patients whose needs could not be met in the community, acute wards have become overcrowded and ‘a bizarre and illogical mixture … of old and young, male and female, psychotic and depressed, retarded and agitated and voluntary and detained’ (Muijen, 1999).