In Pt 3 The Prof was saying Britain hasn’t yet exhausted all potential alternative strategies to admission.
As far as her own list of ‘potential strategies’ goes, er, it’s a bit thin on the ground. There are two. One of them – a crisis house – is not a viable model to replace acute wards. They are good alternatives for a limited kind of well-behaved patient or for women-only non-hospital placements for a time-limited stay.
I’ve admitted patients in crisis to these places and most were a roaring success but crisis houses won’t accept anyone who’s intoxicated, got a hx of violence, needs medical supervision and so on. Therefore, they are not evidence Britain can close acute wards and build more of these.
The main ‘potential strategy’ she offers are crisis resolution teams. Personally I consider this clip to be evidence the author can’t even be honest across two consecutive sentences. See if you can spot them.
‘With regard to alternatives to acute admission, the major NHS investment has been in crisis resolution teams, now operating throughout England. These can, where well implemented, reduce admission, shorten hospital stays and achieve good satisfaction.’
How can any self-respecting academic claim ‘reducing admission and shortening stays’ (which are not desireable things anyway, as I’ll explain in posts to come) equal alternatives to admission. Remember the argument was ‘we don’t need all those horrid psychiatric beds, keep on closing them, there are alternatives we haven’t yet exhausted.’
A short admission does not equal not being admitted. You still need a bed, surrounded by a hospital ward, and doctors, nurses, pharmacists and domestics. Sorry to burst your poorly inflated balloon Prof.
NB There may be a Freudian slip showing though, when she writes, ‘With regard to alternatives to acute admission, …crisis resolution teams…’ I have seen, heard and read CHRT being touted as a service aimed at keeping patients out of hospital.
Take a second look at that sentence. You might have naively thought CHRT was a service for keeping patients in crisis alive, supporting them through their crisis and out the other side, in hospital if necessary, sectioned if necessary. Sorry, overburdened taxpayer. It should be, it used to be but now it isn’t – well at least not in the plans of certain service Commissioners and Trust Boards. I have a strong feeling that closing hospital beds (general and psychiatric) in favour of community treatment is another of those sneaky aims the UN/WHO have got their sticky fingers into. Evidence when I have it.
Just one more, honest. You may have spotted by now that academic, managerial and political untruthfulness, manipulation and so on infuriate me and keep me banging on about them far too long.
This sentence isn’t as dishonest as the others.
‘Joint crisis cards, which are advance agreements with patients about the management of future crises, are one of the few interventions to have shown evidence of reducing compulsory admissions..’
At least she acknowledges these crisis cards reduce only compulsory admissions. But she didn’t add the study reports ‘There was no evidence for differences in bed days (total number of days spent as an inpatient)’ which means the patient was still admitted, just not sectioned. Explain please Prof how this provides an argument fewer inpatient beds are needed?
NB There exists this academic blind-spot, that only published research studies count as evidence. There are, in fact, heaps of different sources. I have 35+ years front line experience, notes and memories. I’m testifying about it here.
In conclusion, remember, I said and showed in the UN/WHO series, when academics can’t find any evidence, they make it up (and still get published.)
Academics and managers enjoying the generous conference facilities
Now as I’ve shown, you can add this; when they are pushing their own righteous agenda (claiming evidence supports closing beds, keeping patients out of mental hospital per se, least restrictive, eradicating restraint and seclusion and so on) they are equally prepared to do the same thing. Caveat lector.
For comparison, read the honest, logically argued counter-post ‘Has the closure of psychiatric beds gone too far? Yes.’ by Dr Tyrer. Don’t expect weapons grade sarcasm and scorn from him though. That’s my speciality.
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