`Gridlock' in secure beds adds to crisis on wards

NICHOLAS TIMMINS

Public Policy Editor

Health managers claim that "gridlock" in the secure beds designed to take the most disturbed and potentially violent offenders has contributed to the dangerous pressures on acute psychiatric wards.

It is one of six factors that have led to what the Mental Health Act Commission has called a "crisis" in mental health services which it says has worsened over the past two years.

The diversion of mentally ill offenders from prison to hospitals has led to the three tiers of locked wards - medium secure, and regional secure units, and the special hospitals such as Broadmoor - "silting up", increasing the difficulty of exchanging patients between them.

At one end of the system, approaching a quarter of Broadmoor's 450 patients could be discharged to a less secure environment if space was available, Liz Hill, clinical unit manager at the special hospital, says.

At the other end, ordinary acute wards are having to handle growing numbers of seriously disturbed patients because they cannot be moved up to more secure accommodation. More medium secure beds are being provided - numbers are due to rise from about 700 to 1,000 by March and 1,200 by December in a pounds 45m programme.

But both the Mental Health Act Commission and the Royal College of Psychiatrists fear that few of the places will be available to support local services. The total still stands well below the 2,000 places that the Butler report calculated were needed 20 years ago. Other factors in the crisis, according to the commission, which acts as a watchdog for patients detained under the Mental Health Act, include:

t An underestimate of how many beds were needed to allow for the occasional relapses that people discharged from long-term care suffer;

t Discovery of previously undetected cases by new community teams;

t Too few 24-hour nursed beds outside hospital for patients who cannot cope on their own;

t Homelessness

t Premature discharge in order to free beds, which produces "revolving door" admissions, where patients suffer early return to hospital.

The result is a more disturbed mix of patients on wards where growing numbers are formally detained. The commission highlighted the case of a martial arts expert who became highly disturbed on an ordinary psychiatric ward. He was put into seclusion but smashed the door. He was only restrained when the police arrived. No secure bed could be found for him for a week, during which time he had to be kept heavily sedated and barricaded into the seclusion room - treatment the staff and commission agreed was "inhumane".

The commission says that while many long-stay patients have successfully transferred to Care in the Community, "there remains a core of patients unable to make the transition and for whom community care is arguably the least preferred option. This reality can be lost in the pressure for change".