Psychiatric inpatient rehabilitation: is there a future?

A review of 105 consecutive admissions to a Hospital Rehabilitation Unit (HRU) over two years showed that only a small minority were still the 'traditional' long stay [new or old]. The Unit has diversified and now also treats patients with acute psychosis transferred from admission wards at a relatively early stage in their convalescence, and patients with chronic psychosis admitted directly from the community. Despite the small proportion of long stay referrals to the HRU, the overall number of inpatients under 65 has fallen substantially, without evidence of the HRU being bypassed. It is concluded that a major part of the decline in numbers occurs independently of patients being discharged. Most patients were admitted to the Unit for sound clinical reasons, despite rather than in default of follow up, and after consideration and sometimes trial of community alternatives. A substantial minority of admissions from the community, however, might have been avoided by increased provision of long term highly supported accommodation. The pattern of use of our HRU suggests that HRUs can continue to play a pivotal role if they retain their primary emphasis on rehabilitation, but extend their remit to include those patients who would previously have become long stay (many of whom are now likely to lose out in the everyday pressures of acute ward psychiatry).