- Peter Tyrer, professor of community psychiatry
- 1Centre for Mental Health, Imperial College, London W8 8RP, UK
I have been a community psychiatrist for the past 45 years. However, I am now rueing the success of the community psychiatric movement in the UK, where the inane chant of “community good, hospital bad” has taken over every part of national policy. At some point in the steady reduction of psychiatric beds, from a maximum of 155 000 in 1954 to 27 000 in 2008, the downward slope has to level off or rise. The national plan is to make further reductions, but for what reason? A judicious mix of community and hospital services is necessary to provide excellence in mental healthcare,1 and when this is well integrated bed use falls spontaneously to a steady level.2 The difficult question to answer is, at what point does a further reduction in beds lead to harm and substandard care?
I believe this point was reached some years ago and that the NHS needs at least 30 000 beds for good psychiatric …