Original Research


Alternatives to Acute Hospital Psychiatric Care in East-End Montreal

Alain D Lesage, MD1,2, Charles Bonsack, MD3, Doris Clerc, MD2, Claude Vanier, MD2, Maryse Charron, MD2, Marc Sasseville, MD2, André Luyet, MD2, Daniel Gélinas, MSW2

Objective: As pressure mounts to reduce the number of costly acute care beds, governments and the literature propose top-down ratios. Is this reasonable and fair to the responsible medical officers who, as the key care providers, will need to admit patients and develop discharge plans in a reduced-beds environment?

Method: Treating physicians of all acute care inpatients on a given day (n = 212) and all new acute care admissions over a 2-week period (n = 125) completed an adapted version of the Nottingham Acute Beds Use Survey (NABUS) Questionnaire.

Results: On a given day, only 62 of 212 inpatients were unsuited for any alternative to acute care hospitalization. A floor ratio of 18 acute care beds per 100 000 inhabitants seems adequate for the catchment area in question, provided that alternatives to hospitalization are fully and efficiently available. Alternatives essentially involve an array of the following: supervised residential settings, day hospitals, and intensive home care (2 to 6 hours weekly). The ratio of intensive home care workers required would be 25 per 100 000 inhabitants.

(Can J Psychiatry 2002;47:49–55)

Résumé : Solutions de rechange pour un hôpital psychiatrique de soins actifs de l’Est de Montréal

Clinical Implications

  • Clinicians recognize the need for both hospitalization and alternatives, such as intensive home care (IHC), day hospital, and supervised residential settings.


  • Attention should be paid not only to the number of beds, but also to the availability and ratios of community-based services such as IHC and supervised residential settings.


  • The strength of current assessment of needs presented here rests not on top-down evaluation but on bottom-up assessment by treating psychiatrists.

Limitations

  • In the end, needs assessment rests on clinical judgement, even when systematically recorded, such as is the case here.


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  • The assessment of needs for supervised residential facilities could not be accomplished with the design of this study, but will be on the research agenda in the near future.