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PAPERS: Adrian Worrall, Anne O'Herlihy, Sube Banerjee, Tony Jaffa, Paul Lelliott, Peter Hill, Angela Scott, and Helen Brook Inappropriate admission of young people with mental disorder to adult psychiatric wards and paediatric wards: cross sectional study of six months' activity BMJ 2004; 328: 867 [Full text]

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Bed availability is only one measure of service capacity

Anne Worrall-Davies, Lesley Hewson, Katherine Kiernan   (15 April 2004)

Bed availability is only one measure of service capacity 15 April 2004
Anne Worrall-Davies, Senior Lecturer in Child & Adolescent Psychiatry Academic Unit of Psychiatry & Behavioural Sciences, 15 Hyde Terrace, Leeds, LS2 9LT, Lesley Hewson, Katherine Kiernan Send response to journal: Re: Bed availability is only one measure of service capacity	Worrall et al (1) state that their study of admissions of young people with mental disorder to adult psychiatric wards and paediatric wards shows an “absolute lack of capacity” in inpatient units, consistent with the views of child and adolescent psychiatrists (2). We question this assertion; the availability of beds is only one measure of the capacity of a service. It is also determined by bed usage, including the length of stay and expected outcome of an admission. This is in turn determined by the capacity and capability of community outpatient Child and Adolescent Mental Health Services services to manage complex cases. There is an urgent need to understand better how demand is generated, and to use this to understand how the whole CAMHS system can work better together to meet the need and ensure the optimal use of inpatient care. Bradford Child and Adolescent Mental Health Services have developed a virtual team to provide intensive home-based support for even severely ill young people. This has been in place for six years and has consistently reduced the use of inpatient beds by 80%. (3). Formal evaluation of this service has been undertaken (Worrall-Davies, personal communication). Nine young people were referred in six months for intensive support: they would have previously been admitted to an in-patient unit; only two required admission, one for seven days, the other for three months (formal admission, Section 3 Mental Health Act). We hope to report the findings in the public domain shortly, including views of the staff working in the virtual team, and of some of the young people who received the service. If this approach could be replicated in other areas the effective availability of beds may increase. We strongly support Worrall’s proposal that other models of service provision are explored as we move nationally towards comprehensive Child and Adolescent Mental Health Services. Lesley Hewson Anne Worrall-Davies Katy Kiernan 1 Worrall A, O'Herlihy A, Banerjee S, Jaffa T, Lelliott P, Hill P, Scott A, Brook H. Inappropriate admission of young people with mental disorder to adult psychiatric wards and paediatric wards: cross-sectional study of six months’ activity. British Medical Journal 2004;328:867-68. 2 Worrall A, O’Herhily A. Psychiatrists’ views of in-patient child and adolescent mental health services: a survey of members of the child and adolescent faculty of the Royal College of Psychiatrists. Psychiatr Bull R Coll Psychiatr 2001;25:219-22. 3 Hewson L Care begins at home: reducing the use of inpatient beds. YoungMinds Magazine 2002;58:3-5. Competing interests: We have no financial competing interests but would like to state that we are currently writing up the findings of our evaluation of an alternative model of care to the adolescent in-patient unit