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Over-occupancy in London's acute psychiatric units — fact or fiction?

Royal College of Psychiatrists Research Unit, 11 Grosvenor Crescent, London SW1X 7EE

Aims and method Inner London psychiatric services face particular pressures. One measure of this is over-occupancy of acute psychiatric beds. Seven census-based surveys were conducted between June 1994 and January 1999 to quantify and monitor problems of inner London acute psychiatric bed provision. The censuses involved 14 inner London mental health services with a combined catchment population of approximately three million. Measures included levels (and changes over time) of occupancy, detention under the Mental Health Act, prolonged hospital stays and ward violence.

Results ‘Minimum’ occupancy levels for the combined services were above 100% at all census points. Occupancy level fell from 122% to 112% between the first and seventh census. This was associated with an increase in bed numbers of 2.5 per 100 000. Levels of detention were consistently at around 50% and violent incidents were high at all census points.

Conclusions Current provision of acute beds remains insufficient to meet service demand. To meet the 85% ward occupancy level recommended by the Royal College of Psychiatrists a further 14 beds or community alternatives per 100000 population would be required.

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