Intended for healthcare professionals

Head To Head

Has the closure of psychiatric beds gone too far? Yes

BMJ 2011; 343 doi: (Published 22 November 2011) Cite this as: BMJ 2011;343:d7457
  1. Peter Tyrer, professor of community psychiatry
  1. 1Centre for Mental Health, Imperial College, London W8 8RP, UK
  1. p.tyrer{at}

Peter Tyrer believes lack of beds is adversely affecting patient care, but Sonia Johnson (doi:10.1136/bmj.d7410) thinks improving community services can take the pressure off wards

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 …

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