Crisis in hospitals over the mentally ill: Watchdog finds overcrowding, understaffing, suicides and regime of 'minimal therapy'. Nicholas Timmins reports

INNER-CITY mental wards are in crisis, with patients committing suicide after being discharged too early so as to admit those even more disturbed, the Mental Health Act Commission said yesterday.

Women on mixed wards, now common in psychiatric units of general hospitals, face sexual molestation from other patients, the watchdog body said. Beds are being used for two, or occasionally three patients as detained patients - 80 per cent of the inmates of some wards - are given 'leave', to allow others in. Beds are being placed in corridors and day rooms while some patients, even after being drugged for the night, have been moved between wards, or even to another hospital or private nursing home, to make way for new admissions.

In its biennial report, the commission details a frightening state of affairs in psychiatric units in the inner cities of London, Liverpool, Birmingham and Manchester and demands 'urgent action'.

About 200,000 psychiatric patients a year are admitted to acute units, perhaps 60,000 to 80,000 to big city hospitals.

Professor Elaine Murphy, vice-chairman of the commission and Professor of Psychiatry at Guy's Hospital, London, said yesterday that the situation was horrific. She 'dreaded' being the on-call consultant at weekends when conditions could be 'like Bedlam' as doctors hunted for a bed and the least disturbed patient to transfer or discharge.

The crisis is not in the old mental hospitals that are being closed but in the modern psychiatric departments of general hospitals that were meant to help replace them. Some of these, particularly where older buildings have been upgraded, are already becoming run-down for lack of maintenance, the commission said.

Less seriously ill patients fear for their safety because of the number of deeply disturbed patients being admitted to inadequately staffed wards, while short-staffing, or inadequate training, has led to the police being called to help to give injections to disturbed patients. On one occasion, 13 police, four in riot gear, turned up.

Professor Murphy said she 'regularly' attended inquests where people had killed themselves shortly after discharge. The commission was trying to compile statistics on such deaths.

The crisis, she said, had arisen over the past two to five years as more of the old long-stay beds and hospitals had closed, and as greater efforts had been made to keep the psychiatrically ill out of prison. Both trends were welcomed by the commission. But the resultant pressure on acute services had pushed them into crisis in the inner cities.

High numbers and turnover of disturbed patients and lack of staff meant patients received 'minimal' therapy. 'For the majority of patients these units appear to offer little beyond residential accommodation, the administration of medication and visits from junior doctors who do not have sufficient expertise,' the commission said. Qualified staff were often engaged in 'controlling rather than treating' with too many senior staff engaged in administrative and clerical duties.

The commission says the NHS funding formula pays too little attention to the needs of inner cities. 'High morbidity levels in inner-city populations, lack of alternatives to admission, problems of homelessness, and poor community service are contributing factors to the crisis.'

Professor Murphy said the issue was not just money, as some of the patients should be in community care, not the acute units, while others could be dealt with far better at home over the few hours or couple of days of a crisis if only existing resources were organised to allow that.

The commission's task is to protect the rights and interests of detained patients and to advise ministers. John Bowis, Under-Secretary of State for Health, said anecdotal evidence that well-planned 24- hour community services can ease the problem needed to be explored, but 'no patient who needs hospital treatment should be turned away'. In London, he said, a review was under way.

Mental Health Act Commission; Fifth Biennial Report 1991-93; HMSO, pounds 9.75