Chapter

Inpatient treatment

Frank Holloway and Lloyd, I. Sederer

in Oxford Textbook of Community Mental Health

Published on behalf of Oxford University Press

ISBN: 9780199565498
Published online July 2011 | e-ISBN: 9780199640478 | DOI: http://dx.doi.org/10.1093/med/9780199565498.003.0094

Series: Oxford Textbooks

Inpatient treatment

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‘Inpatient care is, from the research perspective, the Cinderella of contemporary mental health services’ (Szmukler and Holloway, 2001). Research on the day-to-day practice of inpatient care remains a step-child of psychiatry and a policy vacuum on the role of inpatient treatment characterizes our field today. In the majority of advanced mental health economies large mental hospitals and institutional care has been vanquished by deinstitutionalization that has produced vast numbers of inpatient bed reductions.

Deinstitutionalization was driven by many forces: empirical evidence about the harmful effects of large institutions on patients (Wing and Brown, 1970); a general social movement that emphasized the ‘community’ as a positive resource for helping people (Hawks, 1975); scandals surrounding institutional care (Martin, 1984); cost containment (Kluiter, 1997); concerns about the importance of patients’ liberties and quality of life (Peele and Chodoff, 1999); and improvements in treatment technologies, which included medication, rehabilitation, assertive community treatment, psychological treatments, and crisis care (Ramsay and Holloway, 2007). A consensus developed amongst user groups, government and policy makers, service managers, and practitioners that inpatient treatment represented if not a failure then a barrier to an evolving paradigm of comprehensive community care. However, carers, clinicians in inpatient services, and community mental health staff who recognize the limits of community care however well it is done remain sceptical of such an antihospital proposition.

Chapter.  8958 words.  Illustrated.

Subjects: Psychiatry

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