Is it really safe to cut psychiatric beds in Western Sydney by 15%? A reply to Atkinson et al.

To the Editor

We write in response to a recent article in the Journal, from Atkinson et al. (2019), in which they report on a model that indicates psychiatric beds can be safely cut in Western Sydney by 15%, despite the authors’ own observation that the region is experiencing ‘an increasing trend in hospitalisations for mental health disorder placing pressure on tertiary services’ (p. 3). Mental health admissions have indeed risen faster than population growth (from around 1400 to 1900 per 100,000 population over 15 years), which suggests that bed numbers should be increasing rather than reducing in Western Sydney (www.healthstats.nsw.gov.au/Indicator/bod_hos_cat/bod_hos_cat_comparison).

While the model constructed by Atkinson et al. includes valuable non-inpatient services, these additions should be fully funded, embedded and proven effective before policymakers should even consider reducing inpatient bed numbers in an already overwhelmed system. Western Sydney’s numbers of general adult acute (21 per 100,000 population), long-stay (3 per 100,000 population) and subacute beds (17 per 100,000 population) are far from excessive (https://ro.uow.edu.au/sspapers/2024/). A 15% cut to beds, at a time when demand is increasing, is likely to worsen emergency department (ED) access block in Western Sydney’s acute hospitals with all the clinical problems that this entails (Allison et al., 2018). There has been limited empirical study of the effects of ED access block on population suicide rates, but researchers have noted an inverse correlation between psychiatric bed numbers and suicide rates, most notably in the United States which has an extremely low and declining psychiatry bed base (Bastiampillai et al., 2016).

We suggest that a far safer and more direct approach is supplying psychiatric beds according to demand (Allison et al., 2018). If ED attendances are rising, ED lengths of stay (LOS) are increasing, admission rates are growing, bed occupancy is high, inpatient LOS is being squeezed, and there are many outliers on medical wards, then policymakers should conclude that more beds are required.

Finally, it is important to note that psychiatric inpatient care has a wide variety of uses beyond suicide prevention (www.abc.net.au/news/2014-11-12/professor-marie-bashir-mental-health-centre/5886836). Hence, psychiatric inpatient units around Australia should be funded adequately and use contemporary design with ample natural light and open spaces. We argue that the fast growing, ethnically diverse urban population of Western Sydney deserves inpatient services that are equal to the best in Australia and around the world, in terms of access, quality and sophistication.