Inpatient services

Despite the national reduction in psychiatric bed numbers, there is still a need for some inpatient facilities, whether in a mental hospital, a DGH unit, or a community unit. Separate wards usually exist for the following:

• Acute admissions in general adult psychiatry (usually patients aged 18-65). Sometimes there is a separate intensive care unit for severely disturbed patients.

• Acute admissions in old-age psychiatry (patients over 65 or 75). There may be separate wards for functional illness, and for assessment of dementia cases.

Other facilities are required, such as residential/long-stay rehabilitation, but these may not always be provided by the NHS 'in-house'.

Facilities vary from area to area; some rehabilitation hostels and schemes are run by local authorities or by charitable organizations. It follows in these cases that admission to them is according to their assessment, not by that of psychiatric services. This can lead to delay, if the latter have a different view. Just as the psychiatrist does not have direct authority over the non-medical members of the community mental health team, so the health service cannot direct outside agencies to accept patients, for example, for rehabilitation.

• Various types of supported accommodation are provided by social services and other organizations such as charities and housing associations. They allow patients to be discharged from hospital who would otherwise be unable to cope on their own.

• The NHS still seems to suffer from the fond delusion that the need for long-stay beds has somehow been abolished by the closure of the old psychiatric hospitals, but a small number of patients in each area still do require this. At the moment, at any rate in England, the need is met by patients generally being placed in private nursing homes or hospitals.

More specialized inpatient units exist to cover a wider population, such as a health region. These deal with, for example, forensic cases (secure units), drug and alcohol misuse, adolescent psychiatry, mother and baby care, and eating disorders.

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