Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d3736 (Published 05 July 2011) Cite this as: BMJ 2011;343:d3736
- Patrick Keown, consultant psychiatrist and honorary senior lecturer12,
- Scott Weich, professor of psychiatry3,
- Kamaldeep S Bhui, professor of cultural psychiatry and epidemiology4,
- Jan Scott, professor of psychological medicine2
- 1Tranwell Unit, Queen Elizabeth Hospital, Gateshead NE10 9R, UK
- 2Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
- 3Health Sciences Research Institute, Warwick Medical School, Coventry, UK
- 4Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
- Correspondence to: P Keown patrick.keown{at}ncl.ac.uk
- Accepted 27 May 2011
Abstract
Objective To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced.
Design Ecological analysis.
Setting England, 1988-2008.
Data source Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre.
Main outcome measures Association between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified.
Results The rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation −0.60, 95% confidence interval −1.06 to −0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds.
Conclusion The annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.
Footnotes
Contributors: All authors conceived and designed the study. PK gathered the data and analysed it with SW, with help from JS. All authors were involved in the interpretation of the data. PK wrote the first draft of the manuscript, and all authors were involved in editing consecutive drafts and interpreting the findings. The final draft was approved by all authors. PK and SW are the guarantors.
Funding: None.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. All authors are applicants for an SDO grant pending review to build on these analyses.
Ethical approval: Not required.
Data sharing: No additional data available.
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