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Monitoring inner London mental illness services

Abstract

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Research Unit, Royal College of Psychiatrists, 11 Grosvenor Crescent, London SW1X 7EE
References
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Association of Metropolitan Authorities (1993) Mental Health Services: issues for local government.
Department of Health (1993) Public Health Information Strategy: improving information on mental health. Department of Health.
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House of Commons Health Committee (1994) Better Off in the Community? The care of people who are seriously mentally ill. Volume 1. London: HMSO.
Joint Commission on Accreditation of Healthcare Organizations (1989) Characteristics of clinical indicators. Quarterly Review Bulletin, 15, 330339.
NHSME (1994) Introduction of Supervision Registers for Mentally Ill People from 1 April 1994. HSG(94)5.
North, C., Ritchie, J. & Ward, K. (1993) Factors Influencing the Implementation of the Care Programme Approach. HMSO.
Patrick, M., Higgitt, A. & Holloway, F. (1989) Changes in an inner city psychiatric in-patient service following bed losses: A follow-up of the East Lambeth 1986 survey. Health Trends, 21, 121123.
Royal College of Psychiatrists (1992) Facilities and Services for Patients who have Chronic Persisting Severe Disabilities Resulting from Mental Illness. Council Report CR19. 17 Belgrave Square, London SW1 8PG.
Walker, Z. & Seifert, R. (1994) Violent incidents in a psychiatric care unit. British Journal of Psychiatry, 164, 826828.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Monitoring inner London mental illness services

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