A conceptual model of the aims and functions of acute inpatient psychiatry

Abstract

Background: Acute inpatient care has come under sustained criticism. Services suffer from high occupancy, increased acuity, and patient dissatisfaction with care. The number of beds has been reduced in favour of alternative services.

Aim: To articulate clearly the role of acute inpatient care.

Method: Drawing on research evidence and the experiences of inpatient and community staff, we present a model to describe the function and tasks of inpatient care.

Results: An admission is the result of severity of acute mental disorder, coupled with an acute admission problem. The decision to admit is processed through a filter composed of bed availability, social supports and other services available to the prospective patient. That combined reason provides the primary task of the admission. However patients also bring with them other life and health problems. While not a cause of admission, these problems have to be managed by inpatient staff. Where they can be resolved, they represent an “admission bonus”. Finally, acute care functions because of the legitimate authority of staff, their 24-hour availability for support and supervision, and the provision of treatment and containment.

Conclusion: This model explicates many aspects of acute inpatient care that otherwise create confusion.

Keywords:

• Inpatient services
• acute psychiatry
• crisis
• admission