Radical or what?

As far as the CLAHRC WM Director can discern, the massive closure of in-patient psychiatric beds in the 1970s was not evidence based. It was driven by all sorts of social forces and ideology. That does not mean it was necessarily a bad thing – and of course some psychiatric beds remain. So the real question is “what is the optimal provision for severe mental illness?” According to Sisti et al.[1] current provision is far too low. Some who need beds end up in prison services. Many others may also benefit from inpatient care. Careful comparison between community and hospital care among equipoised patients [2] (i.e. those with no real preference) would go a long way to identifying optimal provision. In the meantime, the CLAHRC WM Director and his colleague Celia Taylor are collaborating with RAND Europe on the evaluation of Liaison and Diversion services, so that people with severe mental illness are diverted to mental health services when they have been arrested. Some of these diverted patients will need inpatient care.

— Richard Lilford, CLAHRC WM Director


  1. Sisti DA, Segal AG, Emmauel EJ. Improving Long-term Psychiatric Care: Bring Back the Asylum. JAMA. 2015; 313(3): 243-4.
  2. Lilford RJ, Jackson J. Equipoise and the ethics of randomization. J R Soc Med. 1995; 88(10): 552-9.

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