letters

I was interested to read the article by Christina Moore and Judith Wolf (cover feature, 24 June) which highlighted the cost of acute psychiatric care and the potential benefits to patients and the NHS of reducing the length of hospital admissions.

Their observation that discharge is often delayed through lack of alternatives in the community and lack of home-based support will be familiar to many mental health professionals. These problems may be further exaggerated for mental health patients with additional needs, illustrated by clinical work with deaf people.

I have recently audited clinical activity in a specialist mental health service for deaf people in Birmingham. The audit compared deaf patients' length of stay with that of hearing patients admitted to the same hospital under the care of a general adult psychiatrist, over a one-year period.

Deaf patients with severe mental illness were more likely to be admitted than their hearing counterparts and were likely to remain in hospital longer. The cost of inpatient care for deaf patients (currently about£390 a day) is significantly higher than for hearing patients, whereas community-based care is not. Consequently, 89 per cent of the annual treatment cost for this patients group resulted from admission costs.

When patients were grouped according to diagnostic category, the inpatient treatment of schizophrenic patients was shown to account for 48 per cent of the annual total. The caseload comprised 238 deaf people, of whom 65 were diagnosed schizophrenic and 28 had an admission within a one-year period. For those patients with acute admissions, admission costs accounted for 96 per cent of the total annual treatment cost.

Deaf people do not require longer admissions to recover from mental health problems, but because of difficulties discharging them into the community.

Any intervention that could reduce admission rates or decrease length of stay could lead to major cost reductions and offer significant benefits to patients.

Increased awareness of deaf people's needs and the development of appropriate skills locally could enable more to be treated in community-based services, reducing the frequency and length of hospital admissions.

This may reduce costs, and would have a beneficial effect on patient care.

Dr Jim Appleford

Senior registrar in psychiatry

South Birmingham Mental Health trust