A multidisciplinary expert consensus on optimal acute adult psychiatric inpatient care in Hong Kong

Dennis Chak Fai Ma¹Kit Ping Chan²Janelle Yorke¹Grace Wing Ka Ho¹Wai Ching Yan³Chi Wing Law⁴Wai Song Yeung⁵Tarun Bastiampillai⁶Adrian P Mundt⁷Sherry Kit Wa Chan^8*

• ¹School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
• ²Kwai Chung Hospital, Hong Kong, Hong Kong, SAR China
• ³Department of Psychiatry, Kowloon Hospital, Kowloon, Hong Kong, SAR China
• ⁴Department of Psychiatry, Queen Mary Hospital, Hong Kong, Hong Kong, SAR China
• ⁵Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong, SAR China
• ⁶Flinders University College of Medicine and Public Health, Adelaide, Australia
• ⁷Universidad Diego Portales Facultad de Medicina, Santiago, Chile
• ⁸Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine School of Clinical Medicine, Hong Kong, Hong Kong, SAR China

Introduction The number of psychiatric inpatient beds has been significantly decreased since the deinstitutionalisation movement began in the 1950s. Subsequent efforts have largely focused on developing psychiatric services based on community mental health models. However, optimal clinical care standards require minimum inpatient care capacities and effective integration between inpatient and community psychiatric care. Methods To establish the optimal number of psychiatric inpatient beds and factors related to optimal adult psychiatric inpatient care in Hong Kong, an online, two-round Delphi survey was used to collect expert opinions from experienced psychiatric nurses, a social worker, and psychiatrists working in public psychiatric inpatient or community settings. Medians and interquartile ranges were calculated for numeric responses. Thematic analysis was used to qualitatively categorise the themes of contextual factors for optimal bed numbers and optimal inpatient care. Expert consensus was reached after two rounds of the online survey according to priori consensus definitions. Results In total, 47 experts were invited to participate. 29 participated in the panel of the first round and 22 in the second round of the Delphi study. 68% had > 20 years post-registration experience. Expert consensus revealed an optimal median number of 68 psychiatric inpatient beds per 100,000 population (interquartile range = 11) and a nurse-patient ratio of 1:4. Two themes were identified relating to recommendations for psychiatric inpatient bed numbers and three themes relating to optimal acute adult psychiatric inpatient services in Hong Kong, respectively. One theme relating to optimal bed numbers was the presence of service needs in the population, such as the prevalence of severe mental illnesses and substance use disorders. Conclusions Experts in Hong Kong reached consensus on the need for more psychiatric beds than currently available to achieve a balanced care system. This study also presents consensus on a nurse-inpatient ratio that would require investments in more staff and has the potential to improve the quality of inpatient treatment and efficiency of care.