BMJ 1994;309:1438 (26 November)

Letters

Future of inpatient adolescent psychiatric units

NHS reforms address existing deficiencies

EDITOR,--Harold Behr and Matthew Hodes are right to be concerned about the future of inpatient adolescent psychiatric units,1 but I believe that they are mistaken to cite the purchaser-provider split as the cause of the problem. The NHS reforms have simply highlighted longstanding deficiencies in the service offered by some inpatient adolescent units.

In 1986 the Health Advisory Service's report Bridges Over Troubled Waters described how in many parts of Britain difficulties had arisen as a result of a divergence between the therapeutic orientation of inpatient units and the expectations of referrers.2 The report recommended that units should abandon exclusive admission policies and a single therapeutic approach in favour of a more eclectic model to widen the range of disorders treated.

In a survey of past and potential referrers to an adolescent inpatient unit in the North Western region the message from referrers was clear.3 . . . [Full text of this article]


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