Reasons behind the rising rate of involuntary admissions under the Mental Health Act (1983): Service use and cost impact

Smith, Shubulade; Gate, Rebecca; Ariyo, Kevin; Taylor, Clare; Bhui, Kamaldeep; Mavranezouli, Ifigeneia; Heslin, Margaret; Greenwood, Helen; Matthews, Hannah; Barnett, Phoebe; Pilling, Stephen

doi:10.1016/j.ijlp.2019.101506

Cited by 24 publications

(25 citation statements)

References 29 publications

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“…The recent overhaul of the MHA 12 includes minimising detentions among Black people and other ethnic minorities which is likely to both improve patient experience 13 and also address the substantial costs to the NHS associated with being detained under section. 14 With regard to suicide, there are few large-scale studies on ethnicity to inform policy and practice; furthermore ethnicity is not routinely recorded on national death registrations in England and…”

Section: Introductionmentioning

confidence: 99%

Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales

Hunt

Richards

Bhui

et al. 2021

The Lancet Psychiatry

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Section: Introductionmentioning

confidence: 99%

Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales

Hunt

Richards

Bhui

et al. 2021

The Lancet Psychiatry

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“…32 An even more recent study has reported no significant association between in-patient bed numbers and detention rates in a multivariate model, for the period from 1999 to 2016. 42 Internationally, greater in-patient bed availability is associated with higher, not lower, rates of compulsory admissions. 1…”

Section: Resultsmentioning

confidence: 99%

Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model

et al. 2020

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Background The steep rise in the rate of psychiatric hospital detentions in England is poorly understood. Aims To identify explanations for the rise in detentions in England since 1983; to test their plausibility and support from evidence; to develop an explanatory model for the rise in detentions. Method Hypotheses to explain the rise in detentions were identified from previous literature and stakeholder consultation. We explored associations between national indicators for potential explanatory variables and detention rates in an ecological study. Relevant research was scoped and the plausibility of each hypothesis was rated. Finally, a logic model was developed to illustrate likely contributory factors and pathways to the increase in detentions. Results Seventeen hypotheses related to social, service, legal and data-quality factors. Hypotheses supported by available evidence were: changes in legal approaches to patients without decision-making capacity but not actively objecting to admission; demographic changes; increasing psychiatric morbidity. Reductions in the availability or quality of community mental health services and changes in police practice may have contributed to the rise in detentions. Hypothesised factors not supported by evidence were: changes in community crisis care, compulsory community treatment and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers. Conclusions Better data are needed about the characteristics and service contexts of those detained. Our logic model highlights likely contributory factors to the rise in detentions in England, priorities for future research and potential policy targets for reducing detentions.

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“…When analyzing, interpreting, and comparing our results, the interplay between patient characteristics, local mental health services peculiarities, and legal regulations must be considered. They regulate and determine the patients’ access to treatment and directly influence therapeutic interventions [6,15,60–62]. In Switzerland, the rate of compulsory admission orders is high compared to other countries, suggesting a relatively low threshold for their use [11,62].…”

Section: Discussionmentioning

confidence: 99%

Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

et al. 2022

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Background Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients. Methods We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected. Results Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ. Conclusions Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.

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Reasons behind the rising rate of involuntary admissions under the Mental Health Act (1983): Service use and cost impact

Cited by 24 publications

References 29 publications

Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales

Suicide rates by ethnic group among patients in contact with mental health services: an observational cohort study in England and Wales

Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model

Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

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