Bed-juggling skills vital in patient care: With mental health services in inner cities reportedly near breaking point, Nicholas Timmins looks at the difficulties at one London hospital

DIANE O'NEILL, a ward manager at Charing Cross Hospital, grabs her bleep and starts counting.

'Well there was one call from the emergency psychiatric service downstairs. Then we had a call from the Gordon Hospital asking if we could admit a patient. One of the consultants in out-patients saw one of his regulars whom he felt needed to be admitted, and I've just had a call from a social worker saying she's going to a day centre where a man is behaving very disruptively and may need admitting. One of our own patients has had to be moved from here to our secure unit at the Horton, but we're taking back a patient from there to give them the space.'

There are 23 beds on Diane's ward, but on this particular afternoon she has 28 patients on the books. 'By tonight it's likely to be 30,' she says, because it is the start of a weekend when some patients can go home on leave.

While Diane is juggling beds, Bernadette leaves. She has spent three weeks in the unit after a breakdown, her second time in the Charing Cross. As she waves farewell, her bed is taken.

Chris Heginbotham, chief executive of the Riverside Mental Health Trust, says: 'We have 150 beds at the Charing Cross, the Chelsea and Westminster, and the Gordon. They are all full, all the time, and we run at over 100 per cent occupancy. It means we are discharging people as soon as we judge that they are able to cope and we are dealing with patients who are more seriously ill than we are really geared up to cope with.'

He goes on: 'It is the patients with less serious disorders, the ones that are not life-threatening, that are losing out. We are just not providing an in-patient service for people with phobias, or who are anxious or neurotic.

'A few weeks ago I was the senior duty manager and we got two emergencies at the Gordon Hospital. We had no beds. No patient could be discharged. We rang 14 NHS hospitals and no one had a bed. No one. We eventually discharged one patient and had to put another into a private psychiatric hospital.'

Mr Heginbotham, a former national director of MIND, says the crisis has arisen because the long-stay mental illness hospitals have finally started to close, and because a government-backed drive to keep the mentally ill out of prison is working.

'At the same time, we've had the Reed report diverting the mentally ill from prison to hospital. It has been almost too successful - the real killer. Without it, we might just have coped. Its aims are admirable, but it's had the effect that people who are very disturbed and damaged, and who can be quite violent, are having to be contained in our secure unit at Horton. The effect is we can no longer easily transfer the more demanding patients out of here. Something must be done to make all these policies add up.'

(Photograph omitted)