Contribution of psychiatric disorders to occupation of NHS beds: analysis of Hospital Episode Statistics

Abstract

Aims and methodWe looked at the contribution of psychiatric disorders to occupancy of National Health Service (NHS) beds in England in the past 11 years, using publicly available data on Hospital Episode Statistics from the financial years 1998–1999 to 2008–2009.ResultsPatients with psychiatric disorders occupied between 14 and 16% of NHS beds in each year examined, and schizophrenia and mood disorders were among the top ten medical diagnoses of people occupying beds in every year. In terms of duration of admission, many individuals with psychiatric disorders, including schizophrenia and mood disorders, had a longer length of admission than those with other medical conditions. In 2008–2009 mean duration of admission for people with schizophrenia was 108 days and for people with mood disorders 42 days. In comparison, people with cerebrovascular disease stayed in hospital for 20 days on average.Clinical implicationsDespite modern treatments, people with psychiatric disorders occupy a large proportion of NHS beds and stay in hospital for considerably longer than those with other medical conditions. Since the independent sector is providing increasing amounts of long-term in-patient care, these figures are likely to underestimate the total burden and costs of treating psychiatric disorders. Community services designed to reduce admissions have yet to have any substantial impact on bed use.

The use of section 135(1) of the Mental Health Act in a London borough

“…Focussing on the dominant ICD F20-29 group also allows a comparison of the length of stay for patients subject to section 135(1) in this study to be made with national hospital admission statistics. The HSCIC's Primary Diagnosis Summary for 2011/2012(HSCIC, 2012 gives a median hospital stay of 30 days for patients with ICD F20-29 diagnoses, vs a median stay of 66 days found in this study. This contrast is more notable in the light of Pillay and Moncrieff's (2011) observations that the national hospital stay figures are likely to be very positively skewed due to the inclusion of a small number of very long stay patients detained under Part III (forensic) sections of the MHA in secure hospitals.…”

“…The HSCIC's Primary Diagnosis Summary for 2011/2012(HSCIC, 2012 gives a median hospital stay of 30 days for patients with ICD F20-29 diagnoses, vs a median stay of 66 days found in this study. This contrast is more notable in the light of Pillay and Moncrieff's (2011) observations that the national hospital stay figures are likely to be very positively skewed due to the inclusion of a small number of very long stay patients detained under Part III (forensic) sections of the MHA in secure hospitals. This group do not form part of the present study as AMHPs have no powers to apply Part III sections.…”

Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010

“…The Prescription Cost Analysis only covers prescriptions issued in the community, and hence excludes drugs issued to patients in hospitals. Since psychiatric patients are hospitalised for longer periods than other patients, 20 the data may underestimate total psychiatric medication use relative to use of other medication groups. It will particularly underrepresent the use and costs of antipsychotic drugs, since most long-term psychiatric in-patients will be taking these drugs.…”

Acute hospital service utilization by inpatients in psychiatric hospitals

“…Service (NHS) hospital admissions are psychiatric disorders [21]. However, defining predictors of longer psychiatric hospital stays remains an elusive goal [22,23].…”