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Margaret McCartney: If this was cancer there’d be an outcry—but it’s mental health

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5407 (Published 04 December 2017) Cite this as: BMJ 2017;359:j5407

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The disappearing act of mental health beds: a rational NHS management plan?

Dear Editors

To give a better perspective on the issue of investment of mental health inpatient care in NHS England, I offer the sobering data from the report from the King's Fund: NHS hospital bed numbers: past, present, future (ref 1)

"Between 1987/8 and 2016/17, the total number of NHS hospital beds fell by approximately 52.4 per cent – from 299,364 to 142,568"

"The largest percentage falls have occurred in overnight mental health and learning disability beds, which fell by 72.1 and 96.4 per cent respectively between 1987/8 and 2016/17." That's from 67,112 to 18,730 for inpatient mental health beds, according for 22..1% of all NHS England hospital bed in 1987/8 down to 13.4% in 2016/7 respectively.

Although it was asserted that this reduction "was underpinned by a policy shift to providing care for people with mental health problems and learning disabilities in the community rather than in institutional settings"

However I believe that this assertion grossly misrepresented the reasons for the decrease in mental health beds. I do not believed that the current mental health inpatient/community care strategy changed in the last decade but the mental health beds were cut by 40% from 26,929 in 2007/8 to 18,730 in 2016/7 (general acute beds fell by 17% in the same period by comparison).

This reduction coincided with the beginnings of the global financial crisis (GFC) and its legacy today, where even more people need help in this area.

This is not an organisation that considered the implication of cuts in inpatient resources; certainly not a rational decision by any NHS manager trying to improve hospital services and reducing overcrowding like some time-based target enthusiasts claimed these managers are doing.

With a lack of suitable inpatient beds and the near-impossibility of ward boarding in psychiatric units (unlike general acute wards) I suspect more people seeking urgent help ended up being shuffled to community services, when inpatient care may have been more appropriate.

Hence the promotion of mental health awareness and training amongst non-traditional care providers, it's another "healthcare on the cheap" initiative. It may address some of those in need but surely the loss of some 3 million bed days annually (compared to a decade ago) must mean something.

We are all under more stress and uncertainty than pre-GFC with the concurrent escalation of austerity measures, Brexit and security risk; surely the cutting of professional services must hurt somewhere.

Perhaps the politicians will only sit up and notice what's going on when something happens closer to home. Until then the NHS will continue to squeeze whatever remaining life out of inpatient mental health services.

Certainly some food for thought, but don't think too long.

References:
1. https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers

Competing interests: No competing interests

05 December 2017
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia