Psychiatric beds under siege from all sides

NICHOLAS TIMMINS

Public Policy Editor

In a small office in the Gordon psychiatric hospital, in central London, sits Alistair Robinson, 31, a registered mental nurse and, since last May, the hospital's bed manager.

It is almost impossible to talk to him. In the space of 20 minutes his bleep goes off seven times, the phone rings five times and he makes six calls out. He is trying to find beds for psychiatric patients who need hospital admission. What is it like? "Horrendous," he grins, sitting beneath a cartoon of an NHS psychiatrist addressing a plant in a flowerbed and telling it: "We need your bed."

On his desk is a directory of NHS and private psychiatric hospitals from the south coast to Glasgow, including 37 secure units where patients who are an active danger to others can be housed. He spent the morning trying to find such a bed for a man the police had arrested but whom his unit's court diversion team had decided was mentally ill and should be cared for in hospital, not prison. "I phoned about 25 of them. Today I didn't quite get to there" - he jabs his finger at the line which says Rainhill Hospital, Preston.

He failed. By 2pm he had been unable to find an empty secure bed anywhere from London and the south coast up to Norwich and Cambridge. Time had run out. "At two o'clock he was up before the judge who remanded him to Brixton for a month. That means we've got a month to find him a bed, or we're up before the beak."

Mr Robinson is also trying to find general psychiatric beds for four patients whom the unit's community psychiatric team say need admission.

The Gordon itself is full - running in fact at 105 per cent occupancy, which means that where a patient is out on leave, another is filling the bed: not good if the trial visit to the outside world breaks down and the patient needs to come back. The Gordon's sister units too are full - "They've been ringing me to ask for beds". In the end, beds are found, one in a private clinic for which the NHS will pay; another where the parents can afford the pounds 3,000 deposit needed for their son to receive private treatment. "That's rare. But it does happen."

Not every day is like this one. But the Gordon is far from unique. Repeated surveys of all 12 of London's mental illness services over the past 18 months by the Royal College of Psychiatrists show bed occupancy running at 120 per cent. Particularly for secure accommodation, patients have to be shipped out to private hospitals in Northampton, Yorkshire and Wales - 200 miles away in some cases - a process that can only disrupt care for people who are already seriously disturbed. In the week before the last survey in July there were 93 assaults on patients or staff, a further 29 which produced minor injury, and two which involved fractures, large lacerations or other serious injury.

According to the Mental Health Act Commission, the statutory watchdog for patients compulsorily detained under the Act, this situation is no longer confined to the big cities. "Occupancy levels of 100 per cent and above have been reported from areas of Devon, East Anglia and Cheshire, as well as all the main connurbations," it says.

The acute, short-term admission wards are caught in a vice, according to mental health managers and doctors.

"Entirely admirable schemes to divert the mentally ill from prison to hospital have increased the load at the same time as the old long-stay beds have continued to close," said Chris Heginbotham, a former national director of Mind who is the chief executive for the service which covers the Gordon. "At the same time unemployment and homelessness have increased pressure from the other end". The result is a service, in the Mental Health Act Commission's words, often "stretched beyond capacity".