The mad world of private asylums

Observations on psychiatry

I recently had a patient whom I thought it right to admit to a psychiatric hospital. As he was privately insured, and as the local National Health Service institutions are noisy, overcrowded, dirty and dismal, I thought it in his interest to get him admitted to the local private hospital.

It was in my interest, too, not because I stood to make any money from it, but I hoped it would save me a lot of time. To get a patient admitted to an NHS psychiatric hospital these days is a labour, if not quite of Hercules, certainly of several hours, with much frustration and at least a score of telephone calls. The number of beds in the system has been so drastically reduced that a single admission causes a bed crisis for miles around. Bureaucratic hurdles have therefore been erected to deter doctors from even trying to admit their patients.

At least in the private sector things would be easy, or so I thought. I would call the hospital, as I have done in the past, nominate the consultant under whose care I wanted to admit the patient, and that would be that.

In the event, the process was just as bad as, if not worse than, the NHS. It took no time at all for the hospital to check that the man was sufficiently insured to pay the bill, but then bureaucracy struck. The staff of the private hospital, trained in the NHS, had recently introduced the same chaotic and time-consuming procedures prevalent in the NHS, and whose principal purpose there is the avoidance of real work, that is to say, the care and cure of patients.

Although I had given the patient's history to the consultant under whose care I wanted to admit him, and to the chief nurse of the ward to which he would be admitted, I was informed by someone further up the administrative hierarchy, a person of the very type that has proliferated in the NHS, that this was insufficient. What was needed before admission was a proper, formal "risk assessment".

I asked what additional information about the patient was needed. No coherent answer was forthcoming. My patient was certainly not a homicidal maniac, and he had no police record. It is true that he was suicidally depressed, but I had already told them so; that, in fact, was the reason I wanted him admitted.

The negotiations went on for six hours, and involved not only me and the administrators of the private hospital, but the consultant to whom I had referred the patient. At the end of this lengthy process, the position was this: the patient could not be admitted until a formal risk assessment had been done, but a formal risk assessment could not be done unless he were admitted. Therefore he could not be admitted.

I found the whole affair very strange. Here was private enterprise turning down bona fide business. Then the reason for it suddenly occurred to me.

Private psychiatric hospitals are no longer interested in taking private psychiatric patients. Such patients are likely to be demanding and difficult. It makes far better commercial sense for private psychiatric hospitals to allow themselves to be used as overspill facilities for the NHS. The patients are likely to be less demanding, the funding is more assured, you can provide them with cheaper food and fewer comforts, and demand exactly the same money. In short, they are more profitable.

It's a mad, mad world, my masters.