There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.
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