The British Journal of Psychiatry (2009) 194: 456-463. doi: 10.1192/bjp.bp.108.051698
© 2009 The Royal College of Psychiatrists
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In-patient and residential alternatives to standard acute psychiatric wards in England

Sonia Johnson, MRCPsych, DM

Department of Mental Health Sciences, University College London

Helen Gilburt, BSc, PhD

Health Services and Population Research Department, Institute of Psychiatry, King’s College London

Brynmor Lloyd-Evans, BA, MSc and David P. J. Osborn, MRCPsych, PhD

Department of Mental Health Sciences, University College London

Jed Boardman, FRCPsych, PhD and Morven Leese, PhD

Health Services and Population Research Department, Institute of Psychiatry, King’s College London

Geoff Shepherd, MPhil, PhD

Sainsbury Centre for Mental Health, London

Graham Thornicroft, FRCPsych, PhD and Mike Slade, DPsych, PhD

Health Services and Population Research Department, Institute of Psychiatry, King’s College London, UK

Correspondence: Sonia Johnson, Department of Mental Health Sciences, University College London, 2nd Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ. Email: s.johnson{at}ucl.ac.uk

Declaration of interest

None.

Background

Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years.

Aims

Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations.

Method

National cross-sectional survey of alternatives to standard acute in-patient care.

Results

We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions.

Conclusions

Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.




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B. Lloyd-Evans, M. Slade, D. Jagielska, and S. Johnson
Residential alternatives to acute psychiatric hospital admission: systematic review
The British Journal of Psychiatry, August 1, 2009; 195(2): 109 - 117.
[Abstract] [Full Text] [PDF]