title: Lessons from an evaluation of major change in adult mental health services: effects on quality.
abstract: BACKGROUND
  The move from inpatient to community services in mental health has sparked debate internationally but the evidence base for successful service models is sparse.
  
  
  OBJECTIVE
  To evaluate the impact of bed reduction on quality of services when accompanied by redesign of community services.
  
  
  METHODS
  Qualitative and quantitative data were collected 6 months before and 6 months after the redesign was implemented.
  
  
  RESULTS
  Bed numbers reduced by 35%. Number of admissions and occupied bed days (OBD) reduced; bed occupancy and proportion of detained patients increased. Access to community services improved but quality of assessments did not. Transitions across pathways were rated as difficult by clinicians. There was an overall reduction in staff numbers; staff sickness levels and dissatisfaction with working conditions increased. Service users were generally positive about the redesign but GPs and staff were not.
  
  
  CONCLUSIONS
  Multi-faceted evaluation of change in cost-pressured services is feasible and should guide developments to minimise negative effects on quality of care.
authors.affiliation: Southern Health NHS Foundation Trust in collaboration with the Princess Royal Trust for Carers , Southampton , UK .
authors.forename: Shanaya
authors.initials: S
authors.lastname: Rathod
authors.forename: Avril
authors.initials: A
authors.lastname: Lloyd
authors.forename: Carolyn
authors.initials: C
authors.lastname: Asher
authors.forename: Jessamy
authors.initials: J
authors.lastname: Baird
authors.forename: Enilson
authors.initials: E
authors.lastname: Mateus
authors.forename: Eva
authors.initials: E
authors.lastname: Cyhlarova
authors.forename: Julie
authors.initials: J
authors.lastname: Cameron
authors.forename: Jenny
authors.initials: J
authors.lastname: Lieshman
authors.forename: Hesham
authors.initials: H
authors.lastname: Elnazer
authors.forename: David
authors.initials: D
authors.lastname: Kingdon
mesh_terms: D001509:Bed Occupancy; D003155:Community Mental Health Centers / Q000458:organization & administration* / Q000600:supply & distribution; D006742:Hospital Bed Capacity; D006760:Hospitalization; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D017060:Patient Satisfaction; D011787:Quality of Health Care
keywords: Change; community care; evaluation; mental health beds