Projection of alternatives to acute psychiatric beds: Review of an emerging service assessment method

Abstract

There has been much concern about the inappropriate use of acute psychiatric in-patient services in the British National Health Service. 'Alternatives Projection' is a pragmatic, observational approach, undertaken against this background, in which clinicians make a judgement on the appropriateness of placements of in-patients and, where necessary, recommend alternative placements. It is then possible to make projections of which alternative services are required. We aimed to review and evaluate this approach and recommend ways in which it might be developed. Nine relevant studies from the 1990s in the UK were reviewed for their robustness, methodology and results. All indicated a significant proportion of inappropriately placed patients, but none used a standardised instrument. 'Alternatives Projection' should play a key role in the planning and evaluating of services, but to achieve this a standardised instrument must be developed, which will algorithmically map the needs and characteristics of patients in any part of the mental health-care system to appropriate accommodation and support. A methodology for turning data from 'Alternatives Projection' exercises into workable health service plans would in turn enhance the value of a standardised instrument.