Lessons from an evaluation of major change in adult mental health services: effects on quality.

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. Aim: 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.