Types of hospitalisation

In psychiatric care, it is possible for a patient to be admitted to a psychiatric service where the patient stays in the institution day and night. This is referred to as residential hospitalisation. In addition, it is possible that a patient stays in the institution only during the day or only at night. This is referred to as partial hospitalisation.

Types of beds for residential hospitalisation 

Psychiatric institutions are often divided into different units according to the therapy or pathology provided. In each unit, there are a number of recognised beds with a specific code letter reflecting the type of care provided:

  • Beds for acute care (code letter A): The neuro-psychiatry service for observation and treatment (day and night) of adult patients in need of urgent care;
  • Beds for chronic care (code letter T): The neuro-psychiatry service for treatment (day and night) of long-term and chronic problems in adults, with a focus on social re-adjustment. In this document, beds for the neuro-psychiatric treatment of geriatric patients (code letter Tg) are included in this category;

  • Beds for specialised care (code letter Sp 6): Specialised service for treatment and rehabilitation for patients with psychogeriatric and chronic conditions;

  • Beds for intensive care (code letter IBE: pilot project since 2009): Intensive treatment unit for adult patients with severe behavioural disorders and/or aggressive adult patients.

The public PH in Geel and Lierneux also have beds and places for “Family placement or psychiatric family care” (code letter Tf). These are atypical of the Belgian hospital landscape and are not covered in this document.

Number of recognised beds for residential hospitalisation
per region and per type of care (01/01/2020)

The above figures show the number of psychiatric beds for adults in absolute numbers. We can see that PDGH primarily consist of beds for acute care (code letter A).

We can also see a significant discrepancy between the different regions. However, when the figures are presented in terms of the number of inhabitants, we see that the contrast between the regions is less pronounced, but that the Flemish region is still in the lead with 138 beds per 100,000 inhabitants. On average, Belgium has 130 residential beds in PH and PDGH combined per 100,000 inhabitants.

Number of recognised beds for residential hospitalisation
per 100,000 inhabitants per region (01/01/2020)

On average in Belgium,in PH and PDGH altogether, we have 130 residential beds per 100,000 inhabitants

The number of beds and their distribution has grown historically. To achieve an even distribution, the federal government introduced programming criteria.

Code letter

Programming criterion

A (PH)

0.50 beds per 1,000 inhabitants

A (PDGH)

0.27 beds per 1,000 inhabitants

T

0.90 beds per 1,000 inhabitants

Sp6 + Tg

0.23 beds per 1,000 inhabitants

IBE

64 beds for Belgium

Number of beds envisaged in the programming and number of recognised beds for residential hospitalisation per region (01/01/2020)[1]

The Brussels-Capital Region has more residential beds for acute care (code letter A) in PDGH per 1000 inhabitants than envisaged by the programming criterion. However, the region has fewer residential beds for acute care (code letter A) per 1,000 inhabitants in PH, which is atypical of the general supply of psychiatric hospital beds.

The total number of psychiatric beds for adults in PH and PDGH for residential hospitalisation fluctuates very little over time. If we look at the last 20 years, we see a status quo in the Walloon Region, an increase of 9.3% in the Flemish Region and of 24.0% in the Brussels-Capital Region.

Evolution of the total number of beds
for residential hospitalisation in PH and PDGH

If we look at the evolution of the number of beds by type of care, we see that there was a shift from beds for chronic care to beds for acute care from 2015 on. This reflects the efforts made in the context of the reforms to mental healthcare. This stipulated that no new beds could be created without phasing out the provision of other beds.

Evolution of the number of recognised beds
for residential hospitalisation by type of care in PH and PDGH

Types of beds and places for partial hospitalisation 

For partial hospitalisation, a distinction is made between the following types of beds and places:

  • Places for acute care for day hospitalisation (code letter a1): The neuro-psychiatry service for observation and treatment for day hospitalisation of adult patients in need of urgent care;

  • Beds for acute care for night hospitalisation (code letter a2): The neuro-psychiatry service for observation and treatment for night hospitalisation of adult patients in need of urgent care;

  • Places for chronic care in day hospitalisation (code letter t1): The neuro-psychiatry service for day hospitalisation for adults with long-term and chronic problems;

  • Beds for chronic care in night hospitalisation (code letter t2): The neuro-psychiatry service for night hospitalisation for adults with long-term and chronic problems;

The services for partial hospitalisation are mainly located in the PH. In PDGH, no beds for night hospitalisation are provided, with the exception of 2 beds for acute care in night hospitalisation (a2 beds) in the Flemish Region. For day hospitalisation, the PDGH mainly provides services for acute care (a1 beds). There is only one PDGH in the Brussels-Capital Region that provides 17 chronic care places in day hospitalisation (t1 beds).

Number of recognised beds for partial hospitalisation
per region and per type of care (1/01/2020) (01/01/2020)

Over the years, we observe a slight decrease in the supply of places in night hospitalisation. The number of places for acute day hospitalisation (a1) is clearly increasing. In practice, this is reflected in an evolution of the supply from more chronic care to acute treatment or day therapy.

Evolution of the number of recognised beds
for partial hospitalisation by type of care in PH and PDGH

In proportion to the number of inhabitants, more places for partial hospitalisation are provided in the Flemish Region, both for day and night hospitalisation. The provision of both day and night hospitalisation is lowest in the Walloon Region.

Number of recognised beds for partial hospitalisation
per 100,000 inhabitants per region (1/01/2020)

Day hospitalisation (a1 and t1) Night hospitalisation (a2 and t2)

In the Brussels Capital Region, we observe that more beds and/or places for day and night hospitalisation are provided in PDGH than described in the programming figures. On the other hand, in PH, only less than half of the beds and/or places are recognised than described in the programming figures.

Code letter

Programming criterion

a1 + a2 (PH)

0.15 beds per 1,000 inhabitants

a1 + a2 (PDGH)

0.075 beds per 1,000 inhabitants

t1 + t2

0.40 beds per 1,000 inhabitants


Number of beds envisaged in the programming
and number of recognised beds for partial hospitalisation
per region (01/01/2020)[1]

 

[1] More information on the programming figures can be found on the following website Figures for programming of hospital beds and Explanatory note for programming of hospital beds