EDITOR,--A recent conference on metropolitan health care highlighted the plight of mentally ill people in London. Of special note was the serious shortage of admission beds in all urban areas in the United Kingdom,1 2 with the bed occupancy rate for mental health now well above 100%, with some units actually running at over 120%.3 Pressure seems greatest in inner London, and it is a far cry from the therapeutic standard of a bed occupancy rate no greater than about 85%.4 Such occupancy would allow patients to be placed in their catchment area ward, with effective aftercare and an allocated key worker, as envisaged in the care programme approach.

This shortage …