Psychiatric Bulletin (2006) 30: 470. doi: 10.1192/pb.30.12.470
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 470
© 2006 The Royal College of Psychiatrists
Admission is not a failure of community care
Rachel Cullivan, Consultant Psychiatrist
St Davnet’s Hospital, Reaskey, Monaghan, Ireland, email:
rachel.cullivan{at}maile.hse.ie
Dr Mackirdy gives an interesting account of the pressures leading to change
within adult psychiatric services (Psychiatric Bulletin, August 2006,
30, 283–285). As a member of a community mental health team I
also have noted with concern what she describes as ‘healthy competition
between the sector teams to have the fewest in-patients’, which may not
be so healthy if it prevents a clinically indicated admission from taking
place. I would also be unhappy with the view of in-patient admission as a
‘failure of community care’. As Dr Mackirdy herself has observed,
the provision of home treatment as an alternative to hospital admission has
been one of the best developments of the past decade. Making an assumption
that all admissions are failures of home treatment would suggest an impressive
evidence base which is simply not yet available
(Joy et al, 2005).
There will always be occasions when admission to a place of safety is
required irrespective of the excellence of the available home treatment team
(Department of Health, 2002).
To view an appropriate clinical decision or indeed patient preference for
admission as a failure of that service would remove any real sense of an
alternative or choice for those availing of our services.
References
DEPARTMENT OF HEALTH (2002) Community
Mental Health Teams – Mental Health Policy Implementation
Guide. London: Department of Health.
JOY, C. B., ADAMS, C. E. & RICE, K. (2005) Crisis intervention for people with severe mental illness
.
Cochrane Library, issue 3. Chichester: Wiley
InterScience.
