Acute psychiatry 'too dangerous for patients'

A LONDON teaching hospital consultant has given up acute psychiatry because of the 'increasing risks' to which he was having to subject patients to keep the service going.

Dr Cosmo Hallstrom, consultant psychiatrist at the Charing Cross Hospital, said he had moved out of acute general psychiatry six months ago because running the service was getting 'too dangerous' for the patients. His disclosure comes after the warning by the Mental Health Act Commission last month that mental health services in Britain's inner cities were 'in crisis'.

Some hospital wards in London, Manchester, Birmingham and Liverpool were running at 120 per cent occupancy, the commission said, with the least ill patients having to be discharged prematurely to admit the most ill. Some patients feared for their safety because of the high levels of highly disturbed patients being detained on the wards under the Mental Health Act. Others were receiving 'minimal' care as staff struggled with the most seriously ill.

Dr Hallstrom, 47, worked in general acute psychiatry at the Charing Cross and Horton hospitals for 12 years but gave up the acute work six months ago. 'It was getting too hairy, too dangerous, not for me, but for the patients,' he said.

'I was getting burn-out. It was becoming increasingly difficult to run a proper service. When I started out as a consultant 12 years ago I had two registrars, an associate specialist and 34 beds from which to run a proper psychiatric service. By the end I had one senior house officer and 17 beds from which to run the same service.

'There were increasing pressures from all kinds of different directions,' Dr Hallstrom, who is a Royal College of Psychiatrists spokesman, said. 'I was having to operate with fewer beds, fewer staff, and more seriously ill patients. Increasingly you were required to tread a finer and finer line, spending your time waiting for something to go very seriously wrong, and I was having to take increasing risks to keep the system going. To do it properly became a great strain, so when the opportunity arose to move sideways I took it. But I do feel a bit guilty, as though I'm leaving a sinking ship'.

Dr Hallstrom now runs a largely out-patient service for patients with anxiety states, depression and tranquilliser addiction.

He said the risks run included at the extreme self-harm, suicide or that the patient might assault someone after being discharged too quickly.

'Those are the dramatic things, but the real and more common risk is that the patient's life breaks down into chaos because they cannot cope and so they have to be re-admitted again earlier. We used to be able to ensure that patients' lives were well organised and straight before we discharged them.'