Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996-2006
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1837 (Published 09 October 2008) Cite this as: BMJ 2008;337:a1837
- Patrick Keown, consultant psychiatrist and honorary senior lecturer1,
- Gavin Mercer, consultant psychiatrist1,
- Jan Scott, professor of psychological medicine2
- 1East Community Mental Health Team, Molineux Street NHS Centre, Newcastle upon Tyne NE6 1SG
- 2University Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne
- Correspondence to: P Keown p.j.keown{at}newcastle.ac.uk
- Accepted 2 August 2008
Abstract
Objective To analyse the number of voluntary and involuntary (detentions under the Mental Health Act 1983) admissions for mental disorders between 1996 and 2006 in England.
Design Retrospective analysis.
Setting England.
Main outcome measures Number of voluntary and involuntary admissions for mental disorders in England’s health service, number of involuntary admissions to private beds, and number of NHS beds for patients with mental disorders or learning disabilities.
Results Admissions for mental disorders in the NHS in England peaked in 1998 and then started to fall. Reductions in admissions were confined to patients with depression, learning disabilities, or dementia. Admissions for schizophrenic and manic disorders did not change whereas those for drug and alcohol problems increased. The number of NHS psychiatric beds decreased by 29%. The total number of involuntary admissions per annum increased by 20%, with a threefold increase in the likelihood of admission to a private facility. Patients admitted involuntarily occupied 23% of NHS psychiatric beds in 1996 but 36% in 2006.
Conclusions Psychiatric inpatient care changed considerably in the decade from 1996 to 2006, with more involuntary admissions to fewer NHS beds. The case mix has shifted further towards psychotic and substance misuse disorders, which has changed the milieu of inpatient wards. Increasing proportions of involuntary patients were admitted to private facilities.
Footnotes
Reuse of information from the “count me in census” and other datasets was covered by the public sector information licence held by Newcastle University.
Contributors: All authors were involved in the conception of the study and interpretation of the data. PK collected the data and wrote the first draft, and is the guarantor. JS revised drafts of the paper. All authors were involved in approving the final draft to be published.
Funding: None.
Competing interests: JS has received funding for continuing medical education talks on psychosocial aspects of bipolar disorders, unrestricted educational grants for research on medication adherence, and been a member of advisory boards for Astra Zeneca, BMS Otsuka, Eli Lilly, GSK, Jansen Cilag, and Sanofi-Aventis. PK has received funding for continuing medical education talks from Jansen Cilag. PK and GM are both employed by the NHS. JS’s clinical practice is entirely within the NHS.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.