Are there too few beds for mental health patients?

17 October 2013

The final paragraph of this article has been amended.

There appears to be almost unanimous agreement that the NHS is failing to care for some of the most vulnerable mental health patients. In response to new data that shows there are now fewer mental health beds in use compared to several years ago, there have been calls for the NHS to reassess its priorities.

The Sun reported that 1,700 beds had been lost due to cuts, while the Guardian, quoting the same figures, warned of a "system stretched to full capacity". 

The source of these claims is Care in the Community magazine, which submitted a mass Freedom of Information request to England's 58 mental health trusts. Of those providing data, 75% (34 of 45 trusts) had reduced the number of their mental health beds. Eight had maintained bed numbers, while only three now had more mental health beds open compared to 2011/12. In total, there are now 1,711 fewer beds.

Supply vs demand

Fewer beds is not in itself a sign of a crisis. However, if demand outstrips supply, then there is potentially a problem. The Royal College of Psychiatrists (RCP) has stated that "optimal" bed occupancy in a mental health ward is 85%. This means that patients are able to be admitted without a long, potentially harmful wait.

As well as requesting information on the total number of beds, Care in the Community also asked each mental health trust to provide a snapshot of their bed occupancy on 1 August 2013. The average occupancy for adult psychiatric wards was 101%. The reason why some NHS trusts have supplied figures of more than 100% is because they are including 'leave' beds in their count - beds that remain available for patients who are spending a period of time outside of hospital.

Although 101% is far above the RCP's ideal average, for other types of mental health beds (including those for children and the elderly) we find an average occupancy rate of 88-91% - a figure much closer to the recommended 85%.

However, if we only pay attention to the average, we're in danger of overlooking the considerable variation between mental health trusts. In addition, data like this - a snapshot of bed occupancy on a particular day - can only be of limited use. After all, we don't know how how typical this day is of the situation at a particular NHS trust.

Hospital treatment v care in the community

NHS England compiles monthly statistics on bed occupancy, including for mental health. The most recent data shows that 1,406 mental health beds have been lost in the past three years, while average bed occupancy has increased - from 87% to 88%. (That Care in the Community has a different figure of 1,700 beds might suggest that its sample is skewed towards NHS trusts where there are now fewer - rather than more - beds.)

Since 2009/10, the number of mental health admissions to hospital has been falling, with the NHS focusing on care 'in the community'. However, as the government's Care Minister pointed out, while it might be appropriate for more people to be treated out of hospital, "beds must be available if patients need them".

Although Care in the Community's data offers us a glimpse into the system, its limited sample cannot be seen as definitive proof of a "crisis". However, the magazine has also compiled evidence which shows that at certain NHS trusts, mental health patients have struggled to access the care they need. While this doesn't confirm that mental health is in a state of emergency, it makes the case for there being pressure on services.

UPDATE (23 October 2013)

In the final paragraph, the sentence "Anecdotal evidence from those on the frontline suggests that there may not be enough beds for mental health patients, but this latest research doesn't confirm that this is the case." has been rewritten. The article now includes a new link to another Care in the Community article.

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