How we commission, deliver, and regulate mental health care has changed dramatically in the past 14 years, but much of what Thornicroft and Strathdee wrote in their 1994 BMJ editorial, “How many psychiatric beds?,” still rings true.1 We are asking the same question today, because inpatient care still accounts for two thirds of the budget of NHS mental health services.2 Despite a phenomenal revolution in mental health services,3 the answer lies outside inpatient units rather than within them.2 3 4 5 6

In the linked study, Keown and colleagues (doi:10.1136/bmj.a1837) perform a retrospective analysis of voluntary and involuntary psychiatric admissions in England between 1996 and 2006.7 They find that the total number of involuntary admissions (detentions under the Mental Health Act) each year increased by 20%, with a threefold increase in the likelihood of admission to a private facility. People who had been admitted involuntarily occupied 23% of NHS psychiatric beds in 1996 but 36% in 2006. When measured against population size, there was a reduction from 96 to 66 beds per …