The future pattern of psychiatric provision in England

The events that led to a reduction in both the size and number of mental hospitals in the United Kingdom are reviewed, and the mental hospitals remaining are shown to be mainly providing care in specialised units. Studies of mental hospital closure have shown that care in the community is generally preferred by patients, although for the "old long stay" the total costs are broadly similar. However, for patients with new illnesses care is undoubtedly much cheaper, and patients acquire fewer secondary handicaps of their psychotic illness. Hospital beds are still needed for a community mental health service; and in inner city areas, where prevalence rates for psychotic illness are higher, there are often too few beds to run an efficient service so that patients needing admission may either not be admitted at all, or be admitted to a distant hospital. The allocation of funds for mental illness to local health authorities takes some account of socio-demographic indicators of illness, but authorities are free to spend more or less than their allocation on the mental illness service. One study suggests that there is an optimal number of beds for a given location and that costs of the service increase if there are either too few or too many beds available. It is argued that for care in the community to succeed there must be adequate numbers of beds available, a range of sheltered residential accomodation in the community, as well as enough staff to provide a service for them. Future changes to the way in which the National Health Service is funded--with resource being allocated by groups of general practitioners--make it likely that there will be a shift of resources towards primary care services.