Community care has led to loss of staff from psychiatric wards
http://www.100md.com
《英国医生杂志》
A new report indicates that the growing emphasis on caring for mental health patients in the community is having a serious effect on hospital care, leading to an exodus of staff and worsening conditions for inpatients.
The survey, by the Sainsbury Centre for Mental Health, was commissioned by the National Institute for Mental Health in England and is one of the most detailed assessments of hospital care ever carried out in England, covering more than 50 trusts and 300 wards.
Nearly a third of ward managers reported that their patients were now more severely ill and had higher levels of need. "More than ever the acute inpatient ward is a place offering critical assistance to people during episodes of extreme psychiatric distress and impaired functioning," say the authors.
At the same time many hospital staff are leaving to join the new community teams. A quarter of wards had lost staff to the community sector in the previous year.
Meanwhile, demand on hospital wards remained intense, with a typical bed occupancy of 100%. The survey points to insufficient leadership, with nearly half of wards having no lead consultant psychiatrist and 13% having no ward manager or nurse above grade F.
Most wards rely heavily on bank and agency staff to fill the gaps left by staff shortages. The average 16 bed ward employs four agency or bank nursing staff each day. The situation is worst in London and the South East.
Some patients have no regular access to social activities or talking therapy. Less than 20% of wards use cognitive behaviour therapy regularly, despite its proven efficacy. And on some wards men and women still have to share bathroom, toilet, and sleeping facilities.
The report, which will be used as a basis for evaluating future change, shows that staff have a rosier view of services than patients. Eighty six per cent of ward managers said that wards were safe, despite a survey last year by the mental health charity Mind showing that most psychiatric patients had suffered verbal or physical aggression.
"Maybe staff regard threats and assault as a normal part of the job," said Mind's chief executive, Richard Brook. "Or perhaps they think that only staff are assaulted, not service users. If so, that's a perception that needs to be challenged."
Community care was now seen as "sexier" than inpatient care, said Trevor Turner, vice president of the Royal College of Psychiatrists. But wards were just as full, because community teams were generating a new clientele. "It doesn't relieve the pressure on the ward," he said.
The survey showed that acute mental health care needed urgent attention, said Angela Greatley, chief executive of the Sainsbury Centre for Mental Health. "In particular we need to tackle the urgent staffing problems many wards face and make the many good practices much more common."(Andrew Cole)
The survey, by the Sainsbury Centre for Mental Health, was commissioned by the National Institute for Mental Health in England and is one of the most detailed assessments of hospital care ever carried out in England, covering more than 50 trusts and 300 wards.
Nearly a third of ward managers reported that their patients were now more severely ill and had higher levels of need. "More than ever the acute inpatient ward is a place offering critical assistance to people during episodes of extreme psychiatric distress and impaired functioning," say the authors.
At the same time many hospital staff are leaving to join the new community teams. A quarter of wards had lost staff to the community sector in the previous year.
Meanwhile, demand on hospital wards remained intense, with a typical bed occupancy of 100%. The survey points to insufficient leadership, with nearly half of wards having no lead consultant psychiatrist and 13% having no ward manager or nurse above grade F.
Most wards rely heavily on bank and agency staff to fill the gaps left by staff shortages. The average 16 bed ward employs four agency or bank nursing staff each day. The situation is worst in London and the South East.
Some patients have no regular access to social activities or talking therapy. Less than 20% of wards use cognitive behaviour therapy regularly, despite its proven efficacy. And on some wards men and women still have to share bathroom, toilet, and sleeping facilities.
The report, which will be used as a basis for evaluating future change, shows that staff have a rosier view of services than patients. Eighty six per cent of ward managers said that wards were safe, despite a survey last year by the mental health charity Mind showing that most psychiatric patients had suffered verbal or physical aggression.
"Maybe staff regard threats and assault as a normal part of the job," said Mind's chief executive, Richard Brook. "Or perhaps they think that only staff are assaulted, not service users. If so, that's a perception that needs to be challenged."
Community care was now seen as "sexier" than inpatient care, said Trevor Turner, vice president of the Royal College of Psychiatrists. But wards were just as full, because community teams were generating a new clientele. "It doesn't relieve the pressure on the ward," he said.
The survey showed that acute mental health care needed urgent attention, said Angela Greatley, chief executive of the Sainsbury Centre for Mental Health. "In particular we need to tackle the urgent staffing problems many wards face and make the many good practices much more common."(Andrew Cole)