Pareto’s law of the vital few: Patient requirements for hospital based non-acute care

Abstract

There has been debate in Australian & New Zealand Journal of Psychiatry (ANZJP) about the required numbers of psychiatric beds in Australia (Allison et al., 2019; Benjamin et al., 2018). While debate has focused on acute beds, Australia also has relatively few hospital based adult non-acute beds (10 per 100,000 persons, according to the Australian Institute of Health and Welfare: www.aihw.gov.au/reports-data/ health-welfare-services/mentalhealth-services/overview). In contrast, the World Health Organisation (www. who.int/mental_health/evidence/atlas/ menta l_hea l th_at las_2017/en/ ) reports that high-income countries have 31 beds per 100,000 in standalone mental health hospitals, while Europe has 34 per 100,000. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Faulty of Adult Psychiatry endorsed a major submission from 48 psychiatrists to the Royal Commission into Victoria’s Mental Health System, which recommends increasing the state’s hospital based adult non-acute beds from 3 per 100,000 to around New South Wales’ (NSW’s) level of 14 per 100,000 – with new beds in university-linked ‘Mental Health Rehabilitation Centres’ that would ‘facilitate much needed research on treatment-resistant psychiatric conditions, and on optimal psychosocial practices in rehabilitation psychiatry’ (The Adult Psychiatry Imperative: https://s3.apsoutheast-2.amazonaws.com/hdp. a u . p r o d . a p p . v i c r c v m h s . files/2915/6765/3776/The_Adult_Psy chiatry_Imperative.pdf). Hospital based non-acute care is designed to reduce the adverse outcomes associated with chronic treatment-resistant illness (Sisti et al., 2015).