Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process.
Journal
Molecular psychiatry
ISSN: 1476-5578
Titre abrégé: Mol Psychiatry
Pays: England
ID NLM: 9607835
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
29
09
2021
accepted:
23
12
2021
revised:
08
12
2021
pubmed:
23
1
2022
medline:
26
5
2022
entrez:
22
1
2022
Statut:
ppublish
Résumé
The required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, the expert panel provided responses exploring estimate ranges for a minimum to optimal numbers of psychiatric beds and three levels of shortage. In a second round, the panel reconsidered their responses using the input from the total group to achieve consensus. The Delphi panel comprised 65 experts (42% women, 54% based in low- and middle-income countries) from 40 countries in the six regions of the World Health Organization. Sixty psychiatric beds per 100 000 population were considered optimal and 30 the minimum, whilst 25-30 was regarded as mild, 15-25 as moderate, and less than 15 as severe shortage. This is the first expert consensus on minimum and optimal bed numbers involving experts from HICs and LMICs. Many high-income countries have psychiatric bed numbers that fall within the recommended range. In contrast, the number of beds in many LMIC is below the minimum recommended rate.
Identifiants
pubmed: 35064234
doi: 10.1038/s41380-021-01435-0
pii: 10.1038/s41380-021-01435-0
pmc: PMC8780043
doi:
Types de publication
Journal Article
Review
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1873-1879Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature Limited.
Références
World Health Organization. Mental Health Atlas 2017. https://www.who.int/publications/i/item/9789241514019 (2018). Accessed 1 Jan 2022.
Mundt AP, Serri ER, Siebenförcher M, Alikaj V, Ismayilov F, Razvodovsky YE, et al. Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990–2019: a retrospective database analysis. Lancet Reg Health Eur. 2021;7:100137.
Organisation for Economic Cooperation and Development. Hospital beds. https://www.oecd-ilibrary.org/content/data/0191328e-en (2018). Accessed 1 Jan 2022.
Siebenförcher M, Fritz FD, Irarrázaval M, Salcedo AB, Dedik C, Orellana AF, et al. Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: rates, trends and an inverse relationship between the two indicators. Psychol Med. 2020:1–10. https://doi.org/10.1017/S003329172000269X . Online ahead of print.
Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand. 2010;121:84–93.
doi: 10.1111/j.1600-0447.2009.01438.x
Lora A, Sharan P. Information for global mental health. Glob Ment Health. 2015;2:e17–e17.
doi: 10.1017/gmh.2015.15
Saxena S, Sharan P, Saraceno B. Budget and financing of mental health services: baseline information on 89 countries from WHO’s project atlas. J Ment Health Policy Econ. 2003;6:135–43.
pubmed: 14646006
Rapp MA, Kluge U, Penka S, Vardar A, Aichberger MC, Mundt AP, et al. When local poverty is more important than your income: mental health in minorities in inner cities. World Psychiatry. 2015;14:249–50.
doi: 10.1002/wps.20221
Gigantesco A, de Girolamo G, Santone G, Miglio R, Picardi A. Long-stay in short-stay inpatient facilities: risk factors and barriers to discharge. BMC Public Health. 2009;9:306.
doi: 10.1186/1471-2458-9-306
Lee S, Rothbard AB, Noll EL. Length of inpatient stay of persons with serious mental illness: effects of hospital and regional characteristics. Psychiatr Serv. 2012;63:889–95.
doi: 10.1176/appi.ps.201100412
Mundt AP, Chow WS, Arduino M, Barrionuevo H, Fritsch R, Girala N, et al. Psychiatric hospital beds and prison populations in South America since 1990: does the Penrose hypothesis apply? JAMA Psychiatry. 2015;72:112–8.
doi: 10.1001/jamapsychiatry.2014.2433
Pinals DA, Fuller DA. The vital role of a full continuum of psychiatric care beyond beds. Psychiatr Serv. 2020;71:713–21.
doi: 10.1176/appi.ps.201900516
Minas H, Jorm AF. Where there is no evidence: use of expert consensus methods to fill the evidence gap in low-income countries and cultural minorities. Int J Ment Health Syst. 2010;4:33.
doi: 10.1186/1752-4458-4-33
Jorm AF. Using the Delphi expert consensus method in mental health research. Aust N. Z J Psychiatry. 2015;49:887–97.
doi: 10.1177/0004867415600891
Torrey EF, Entsminger K, Geller J, Stanley J, Jaffe DJ. The shortage of public hospital beds for mentally Ill persons - A report of the treatment advocacy center. 2008.
Muller C. The future of the psychiatric institution: Utopia or reality? [The future of the psychiatric institution: Utopia or reality?]. Soc Psychiatry. 1973;8:185–91.
doi: 10.1007/BF00577850
Gordon A. Psychiatric bed levels. Position paper. Can Psychiatr Assoc Bull. 1997;29:1–4.
O’Reilly R, Allison S, Bastiampiallai T. Observed outcomes: an approach to calculate the optimum number of psychiatric beds. Adm Policy Ment Health. 2019;46:507–17.
doi: 10.1007/s10488-018-00917-8
Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS ONE. 2011;6:e20476.
doi: 10.1371/journal.pone.0020476
Niederberger M, Spranger J. Delphi technique in health sciences: a map. Front Public Health. 2020;8:457–457.
doi: 10.3389/fpubh.2020.00457
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
doi: 10.1191/1478088706qp063oa
The World Bank. World Bank Country and Lending Groups. 2021.
World Health Organization. Working with the regions. https://www.who.int/chp/about/regions/en/ (2021), Accessed 2021.
Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15:353–75.
doi: 10.1016/S0169-2070(99)00018-7
André Q. Outlier exclusion procedures must be blind to the researcher’s hypothesis. J Exp Phychol Gen. 2021. PubMed PMID: 34060886.
Allison S, Bastiampillai T, Licinio J, Fuller DA, Bidargaddi N, Sharfstein SS. When should governments increase the supply of psychiatric beds? Mol Psychiatry. 2018;23:796–800.
doi: 10.1038/mp.2017.139
Tyrer P. Has the closure of psychiatric beds gone too far? Yes. BMJ. 2011;343:d7457.
doi: 10.1136/bmj.d7457
Bloom JD, Krishnan B, Lockey C. The majority of inpatient psychiatric beds should not be appropriated by the forensic system. J Am Acad Psychiatry Law Online. 2008;36:438.
Knable M. William Whitney godding and the concepts of asylum and therapeutic community. Psychiatr Ann. 2015;45:45–48.
doi: 10.3928/00485713-20150106-09
Wall BW. State Hospitals as “the most integrated setting according to their needs”. J Am Acad Psychiatry Law. 2013;41:484–7.
pubmed: 24335318
Okasha A, Karam E. Mental health services and research in the Arab world. Acta Psychiatr Scand. 1998;98:406–13.
doi: 10.1111/j.1600-0447.1998.tb10106.x
Okasha A, Karam E, Okasha T. Mental health services in the Arab world. World Psychiatry. 2012;11:52–54.
doi: 10.1016/j.wpsyc.2012.01.008
Haselden M, Corbeil T, Tang F, Olfson M, Dixon LB, Essock SM, et al. Family involvement in psychiatric hospitalizations: associations with discharge planning and prompt follow-up care. Psychiatr Serv. 2019;70:860–6.
doi: 10.1176/appi.ps.201900028
Smith TE, Abraham M, Bolotnikova NV, Donahue SA, Essock SM, Olfson M, et al. Psychiatric inpatient discharge planning practices and attendance at aftercare appointments. Psychiatr Serv. 2017;68:92–95.
doi: 10.1176/appi.ps.201500552
Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental health service provision in low- and middle-income countries. Health Serv Insights. 2017;10:1178632917694350.
pubmed: 28469456
pmcid: 5398308
Murali V, Oyebode F. Poverty, social inequality and mental health. Adv Psychiatr Treat. 2004;10:216–24.
doi: 10.1192/apt.10.3.216
Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D. Economic barriers to better mental health practice and policy. Health Policy Plan. 2006;21:157–70.
doi: 10.1093/heapol/czl003
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370:878–89.
doi: 10.1016/S0140-6736(07)61239-2
Mundt AP, Delhey Langerfeldt S, Rozas Serri E, Siebenförcher M, Priebe S. Expert arguments for trends of psychiatric bed numbers: a systematic review of qualitative data. Front Psychiatry. 2021;12:745247. https://doi.org/10.3389/fpsyt.2021.745247 .
doi: 10.3389/fpsyt.2021.745247
pubmed: 35002794
pmcid: 8738080