The theory behind deinstitutionalization was that if psychiatric patients were treated in the community instead, there no longer would be much need for hospital beds. On this premise, 90% of America’s state hospital beds have vanished since 1960.
Now comes a report in the British Medical Journal that there is a clear and predicable relationship between a decrease in the number of psychiatric beds and an increase in court-ordered hospitalization. In other words, eliminating involuntary inpatient treatment increases the number of involuntary patients. In England between 1988 and 2008, mental illness beds decreased by 62% and involuntary admissions increased by 64%, according to the authors. They also note in passing that psychiatric hospitals have become “more disturbed and even more stigmatized” as admitting patients have arrived in a more acute state of illness.
“Mental illness beds and rate of involuntary admissions” (July 5, 2011) is based on data in England for the two decades between 1988 and 2008. “Closure of beds for people with mental illness in high income countries has been part of policies to deinstitutionalize the care of people with mental illness…,” according to authors Patrick Keown, Scott Weich and others. “However, the rates of involuntary admissions have been increasing …. This trend has continued despite the development of a range of community based services such as community mental health teams, assertive outreach, crisis resolution home treatment, and early intervention services. Most of these probably reduce voluntary rather than involuntary admissions.”
If you live in one of the (many) states where hospital beds are being eliminated in the name of fiscal austerity (say, Massachusetts, where 120 hospital beds were eliminated last year, or New Jersey, where the only hospital for elderly patients was just axed), this would be a good study to print out and send to your lawmakers. As the authors conclude with characteristic British understatement, “Ultimately this study provides important evidence for the need to anticipate the effects of bed closures.”
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