Debate: The role of inpatient units is to support community care

In child and adolescent mental health care, the evidence base we have is for care in the community. The role of inpatient units is to support that care. Risk can be effectively managed in the context of acute psychotic illness. Some contribution can be made with suicidal adolescents, including sharing risk. Particular aspects of inpatient care can contribute to community care in many scenarios in terms of use of different sorts of assessment information, extended 24/7 contact enabling different opportunities for building rapport and shifting systems and stuck behaviour patterns. To support community teams effectively when such support is needed, inpatient units need to maintain empty beds. Self-determination Theory provides an evidence base showing that when people experience relatedness, autonomy and competence, they experience increased well-being, and intrinsic motivation can guide inpatient care. Interactions with patients and families, staff in the unit and community teams the unit is serving can be focussed to optimise experience of relatedness, autonomy and competence in all these groups. The potential is for every interaction to be a therapeutic interaction.