Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Markers of inappropriate placement in acute psychiatric inpatient care: a five hospital study

  • 39 Accesses

  • 3 Citations


Background: Previous researchers in the UK have measured the prevalence of the `inappropriateness' of acute adult psychiatric inpatient placements by eliciting the judgements of health professionals. We extended the methodology by identifying inpatient sub-groups with stable characteristics that were associated with elevated risk of inappropriate placement, and by calculating the level of that risk. Methods: A 1-day census was taken in five hospitals. Using a structured instrument, consultant psychiatrists recorded judgements on current placements, recommended alternative placements and stated why alternatives had not been used. Judgements were obtained for 100% of the 261 inpatients. Risk ratios and adjusted odds ratios were calculated to identify sub-groups that were at high risk. Results: Eighty-eight inpatients were inappropriately placed, a point prevalence of 34% (95% CI 28–40%). Consultants recorded that services outside hospital, if available, could have supported most of these inpatients as an alternative to at least part of their hospital stay. Diagnostic rather than socio-demographic or administrative characteristics, in particular primary diagnoses of substance-related disorder, personality disorder, anxiety/stress, and schizophrenia with co-morbid substance misuse, were the strongest markers of elevated risk. Conclusions: The point prevalence of inappropriate placement within the British mental health-care system is considerable. Diagnostic categories are reasonable pragmatic markers. Further research should aim to identify a strong marker of risk within the numerically large sub-group of schizophrenia without substance misuse.

This is a preview of subscription content, log in to check access.

Author information

Additional information

Accepted: 17 March 1999

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bartlett, C., Evans, M., Holloway, J. et al. Markers of inappropriate placement in acute psychiatric inpatient care: a five hospital study. Soc Psychiatry Psychiatr Epidemiol 34, 367–375 (1999). https://doi.org/10.1007/s001270050157

Download citation


  • Schizophrenia
  • Personality Disorder
  • Point Prevalence
  • Psychiatric Inpatient
  • Substance Misuse