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EDITOR,--I run a community psychiatric service adjacent to that of Charles Tannock in the west end of London.1 It is particularly closely integrated with social services and fully observes the principles of care management and the care programme approach.
I suspect that psychiatric tourism is well known. I have repeatedly presented audits showing that the phenomenon has an impact on our inpatient service. The data show that about half of the patients admitted are homeless (people staying in hostels are counted as having a home) and half (not a tenth, as Tannock and Turner state) are from overseas, with much overlap. Because of essential underprovision, the above factors, and clinically inappropriate admissions bed occupancy is extremely high. Patients are repeatedly transferred through multifarious overflow arrangements, which defies good practice.
Management and the local purchasers know the situation, but the forces and accountabilities of community psychiatry are equal
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