When should governments increase the supply of psychiatric beds?
When should governments increase the supply of psychiatric beds?
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DOI：
10.1038/mp.2017.139
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发表时间：
2018-04-01
影响因子：
11
通讯作者：
Sharfstein, S. S.
中科院分区：
文献类型：
--
作者：
Allison, S.;Bastiampillai, T.;Sharfstein, S. S.
以医院为基础的精神科床位数量少给严重精神疾病(SMI)患者带来了问题，因为他们面临着更长的急诊科(ED)等待、更高的急性床位入院门槛，以及短暂的旋转门停留时间和高再住院率。获得住院治疗的机会有限与更高的自杀风险、过早死亡、无家可归、暴力犯罪和监禁有关。最终，患有SMI的人可以跨机构进入刑事司法系统。例如，在美国，监狱已经取代精神病院，成为收容SMI患者的最大机构。对于减少这些风险所需的急性、法医和康复床位的安全最低数量，国际上没有达成共识。因此，经济合作与发展组织(经合组织)国家在医院床位组合方面差异很大，平均每10万人有71张床位。政策制定者面临着艰难的选择，几乎没有研究来指导有关床位供应的决策。英国皇家精神病学学院提供了一个政策框架，该框架适用于澳大利亚。南澳大利亚州政府增加了危机床位、急症床位和法医床位的供应，以实现安全减少急诊室精神健康寄宿的强制性目标。
Low numbers of hospital-based psychiatric beds create problems for people with severe mental illness (SMI), when they face extended emergency department (ED) waits, higher thresholds for admission to an acute bed, and short revolving-door stays with high rates of rehospitalisation. Limited access to inpatient treatment has been associated with higher suicide risk, premature mortality, homelessness, violent crime and incarceration. Ultimately, people with SMI can be transinstitutionalised to the criminal justice system. In the USA, for example, prisons have replaced mental hospitals as the largest institutions housing people with SMI. There is no international consensus on the safe minimum numbers of acute, forensic and rehabilitation beds needed to reduce these risks. As a consequence, Organisation for Economic Cooperation and Development (OECD) countries have wide variations in the mix of hospital beds with an average of 71 beds per 100 000 population. Policymakers face difficult choices with few studies to guide decisions on supplying beds. The UK Royal College of Psychiatrists offered a policy framework, which was adapted for Australia. The government of the State of South Australia increased the supplies of crisis, acute and forensic beds to meet a mandatory target to safely reduce mental health boarding in the EDs.