As a mental health nurse working on an acute ward, I found that all too frequently the handover I was given contained the dreaded words “two in a bed”. We didn’t physically have two patients sharing a bed, although a glance at the list of patients might make you think we were. This phrase referred to one patient being on leave and another patient being admitted in their absence. So a 20-bedded ward could technically be accommodating 21, 22 or more patients. Often, this meant the leave patient would return to find no bed available.
Sectioned mental health patients are given leave as part of their recovery process. As they show signs of improvement they are prescribed periods of leave either with nursing staff, with relatives or unescorted. These periods of leave become longer as they near discharge with the intention that being discharged home will be a natural progression.
However, due to bed pressures, patients would sometimes return to the ward at this critical point in their recovery to find that the support network they felt they had on the ward was no longer there. They were either asked to spend more time on leave or moved to another ward. Frequently, this led to patients being moved or discharged to “free-up” a bed, not always leaving them time to fully recover from their acute illness.
Of course the main reason for leave beds being used is the pressure being put on bed management to find a bed for an emergency admission. As many of the patients on mental health wards are so called “revolving door” patients, this raises the question that perhaps if we didn’t discharge simply to free up a bed but allowed time for a full recovery, would this reduce the number of patients requiring admission?