Intended for healthcare professionals

Head To Head

Has the closure of psychiatric beds gone too far? No

BMJ 2011; 343 doi: (Published 22 November 2011) Cite this as: BMJ 2011;343:d7410
  1. Sonia Johnson, professor of social and community psychiatry12
  1. 1University College London, London, UK
  2. 2Camden and Islington NHS Foundation Trust, London, UK
  1. s.johnson{at}

Peter Tyrer (doi:10.1136/bmj.d7457) believes lack of beds is adversely affecting patient care, but Sonia Johnson thinks improving community services can take the pressure off wards

Four ideas, each flawed, underpin views that bed closure has gone too far in the UK. These are that inpatient provision is now meagre, that community care policies result in high levels of antisocial behaviour and failure to sustain community living, that inpatient wards are an environment conducive to dealing with the major problems associated with severe mental illness, and that we have exhausted potential strategies for reducing reliance on beds. I will challenge each of these ideas in turn.

Our bed numbers are not especially low

Bed numbers have fallen steadily since the mid-1950s. However, at 60.6 psychiatric beds per 100 000 population, recent World Health Organization figures place UK provision in the middle of the European range, which extends from 10.6 per 100 000 in Italy to 180.1 in Belgium; Germany, Sweden, Denmark, and Spain are among the countries with fewer beds than the UK.1 Our rates of involuntary admission are fairly high in international context.2 Current levels of bed use in the UK are thus unremarkable.

Community care is not toxic

The second idea, that deinstitutionalisation has unleashed a cohort of mentally ill people who …

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