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Rojas-García A, Dalton-Locke C, Sheridan Rains L, Dare C, Ginestet C, Foye U, Kelly K, Landau S, Lynch C, McCrone P, Nairi S, Newbigging K, Nyikavaranda P, Osborn D, Persaud K, Sevdalis N, Stefan M, Stuart R, Simpson A, Johnson S, Lloyd-Evans B. Investigating the association between characteristics of local crisis care systems and service use in an English national survey. BJPsych Open 2023; 9:e209. [PMID: 37920101 PMCID: PMC10753954 DOI: 10.1192/bjo.2023.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. AIMS To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. METHOD Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. RESULTS No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. CONCLUSIONS The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.
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Affiliation(s)
- Antonio Rojas-García
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Psychiatry, University of Granada, Spain
| | | | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Ceri Dare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Cedric Ginestet
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Sabine Landau
- NIHR Mental Health Policy Research Unit, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Chris Lynch
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Paul McCrone
- NIHR Mental Health Policy Research Unit, Institute for Lifecourse Development, University of Greenwich, UK
| | - Shilpa Nairi
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Department of Primary Care and Public Health, Brighton & Sussex Medical School, University of Sussex, UK
| | - David Osborn
- Department of Psychiatry, University of Granada, Spain; and Camden and Islington NHS Foundation Trust, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; and NUS Centre for Behavioural & Implementation Science Interventions, Singapore
| | - Martin Stefan
- Mental Health Addictions and Intellectual Disability Directorate, Te Whatu Ora (Southern), Dunedin, New Zealand
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
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McBride O, Duncan C, Twigg L, Keown P, Bhui K, Scott J, Parsons H, Crepaz-Keay D, Cyhlarova E, Weich S. Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England. Psychol Med 2023; 53:458-467. [PMID: 34011424 PMCID: PMC9899561 DOI: 10.1017/s0033291721001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.
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Affiliation(s)
| | | | - Liz Twigg
- University of Portsmouth, Portsmouth, UK
| | - Patrick Keown
- Academic Psychiatry Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
- The World Psychiatric Associations UK Collaborating Centre, London, UK
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Helen Parsons
- Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Eva Cyhlarova
- London School of Economics and Political Science, London, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Sashidharan SP, Mezzina R, Puras D. Reducing coercion in mental healthcare. Epidemiol Psychiatr Sci 2019; 28:605-612. [PMID: 31284895 PMCID: PMC7032511 DOI: 10.1017/s2045796019000350] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/07/2022] Open
Abstract
AIMS To examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual. METHODS We identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded. RESULTS Coercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual. CONCLUSION All forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.
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Affiliation(s)
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, WHO Collaborating Centre for Research and Training, ASUI Trieste, Italy
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Lithuania
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Hielscher E, Diminic S, Harris M, Castle D, Lee YY, Kealton J, Whiteford H. Impact of the carer on length of hospital stay for mental health: Results from two Australian surveys. Int J Ment Health Nurs 2019; 28:436-447. [PMID: 30246493 DOI: 10.1111/inm.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Informal carers play a vital role in supporting Australians living with a mental illness, including during the acute phases of illness; however, little is known about their impact on length of hospital stay. We aimed to investigate the impact of having a carer and of carer burden on length of hospital stay for mental health. Two Australian datasets were used. Data from the 2010 National Survey of High Impact Psychosis (n = 1825) were used to investigate the impact of having versus not having a carer on length of hospital stay for mental health. Data from the UQ Carer Survey 2016 (n = 105), a convenience sample of mental health carers, were used to investigate the impact of weekly hours of care (a measure of objective carer burden) on length of stay. Multiple logistic regression and correlation analyses were performed to investigate the association between carer status/burden and length of stay. Having a carer was associated with a significantly longer length of hospital stay; however, this relationship was no longer significant after adjusting for diagnosis, global functioning, depressive symptoms, deliberate self-harm, mental health outpatient contacts and type of admission. Weekly hours of care did not significantly impact on length of stay. Patients with carers had poorer functioning which may be related to longer stays. Our analysis was not able to look at subgroups of carers with different needs. Future work is required to determine other components of the admission and discharge process where having a carer is influential.
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Affiliation(s)
- Emily Hielscher
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Diminic
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Meredith Harris
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Castle
- University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Yong Yi Lee
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jan Kealton
- Carer Consultant, Gold Coast, Queensland, Australia
| | - Harvey Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Kisely S, Xiao J. Cultural and linguistic diversity increases the likelihood of compulsory community treatment. Schizophr Res 2018; 197:104-108. [PMID: 29249560 DOI: 10.1016/j.schres.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND People from culturally and linguistically diverse (CALD) backgrounds are over-represented in compulsory admissions to hospital but little is known about whether this also applies to community treatment orders (CTOs). AIMS We investigated any differences between Australian- and foreign-born patients in the likelihood of CTO placement using state-wide databases from Western Australia. METHODS Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Logistic regression was then used to identify potential predictors of a CTO. We also assessed if any differences in CTO placement between Australian- and foreign-born patients had effects on bed-days or community contacts in the subsequent year. RESULTS We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n=5916). Of these, 74% had schizophrenia or other non-affective psychoses. Patients who were born in New Zealand, the United Kingdom or Ireland had very similar rates of CTO placement compared to those who were Australian-born. By contrast, there was a gradient of increasing risk of CTO placement for people born in Continental Europe (ORadj=1.36; 95% CI=1.07-1.71, p=0.01) and then the Rest of the World (ORadj=1.61; 95% CI=1.31-1.97, p<0.001). However, there was no evidence of additional benefit in terms of health service use in the following year. CONCLUSIONS In common with other coercive treatments, people from culturally and linguistically diverse (CALD) backgrounds are more likely to be placed on CTOs. Further research is needed to establish if this is for similar reasons.
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Affiliation(s)
- Steve Kisely
- The University of Queensland School of Medicine, QLD, Australia; Metro South Health Service, Woolloongabba, QLD, Australia; Griffith Institute of Health, Griffith University, QLD, Australia; Dalhousie University, Department of Psychiatry, Halifax, Nova Scotia, Canada; Dalhousie University, Department of Community Health and Epidemiology, Halifax, Nova Scotia, Canada.
| | - Jianguo Xiao
- Health Department of Western Australia, Perth, Australia
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Singh SP, Paul M, Parsons H, Burns T, Tyrer P, Fazel S, Deb S, Islam Z, Rugkåsa J, Gajwani R, Thana L, Crawford MJ. A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise? BMC Psychiatry 2017; 17:246. [PMID: 28693512 PMCID: PMC5504787 DOI: 10.1186/s12888-017-1391-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007. METHOD A prospective, quantitative study of MHA assessments undertaken between July-October 2008-11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases. RESULTS The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher's exact Χ 2 p = 0.735). Only patients with LD and 'any other disorder or disability of the mind' were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients. CONCLUSIONS In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs.
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Affiliation(s)
- Swaran P. Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford-upon-Avon, UK
| | - Helen Parsons
- Division of Health Sciences, Warwick Medical School, Coventry, UK
| | - Tom Burns
- University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter Tyrer
- Imperial College London, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, London, UK
| | - Seena Fazel
- University of Oxford, Warneford Hospital, Oxford, UK
| | - Shoumitro Deb
- Imperial College London, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, London, UK
| | - Zoebia Islam
- LOROS (The Leicestershire and Rutland Hospice), Leicester, UK
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lavanya Thana
- Imperial College London, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, London, UK
| | - Michael J. Crawford
- Imperial College London, Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, London, UK
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Keown P, McBride O, Twigg L, Crepaz-Keay D, Cyhlarova E, Parsons H, Scott J, Bhui K, Weich S. Authors' reply. Br J Psychiatry 2016; 209:528-529. [PMID: 27908857 DOI: 10.1192/bjp.209.6.528a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Patrick Keown
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Liz Twigg
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Crepaz-Keay
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Eva Cyhlarova
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan Scott
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamaldeep Bhui
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Scott Weich
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne. ; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Keown P, McBride O, Twigg L, Crepaz-Keay D, Cyhlarova E, Parsons H, Scott J, Bhui K, Weich S. Rates of voluntary and compulsory psychiatric in-patient treatment in England: an ecological study investigating associations with deprivation and demographics. Br J Psychiatry 2016; 209:157-61. [PMID: 27284079 DOI: 10.1192/bjp.bp.115.171009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/29/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual variables and area-level variables have been identified as explaining much of the variance in rates of compulsory in-patient treatment. AIMS To describe rates of voluntary and compulsory psychiatric in-patient treatment in rural and urban settings in England, and to explore the associations with age, ethnicity and deprivation. METHOD Secondary analysis of 2010/11 data from the Mental Health Minimum Dataset. RESULTS Areas with higher levels of deprivation had increased rates of in-patient treatment. Areas with high proportions of adults aged 20-39 years had the highest rates of compulsory in-patient treatment as well as the lowest rates of voluntary in-patient treatment. Urban settings had higher rates of compulsory in-patient treatment and ethnic density was associated with compulsory treatment in these areas. After adjusting for age, deprivation and urban/rural setting, the association between ethnicity and compulsory treatment was not statistically significant. CONCLUSIONS Age structure of the adult population and ethnic density along with higher levels of deprivation can account for the markedly higher rates of compulsory in-patient treatment in urban areas.
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Affiliation(s)
- Patrick Keown
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Orla McBride
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Liz Twigg
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Crepaz-Keay
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Eva Cyhlarova
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan Scott
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamaldeep Bhui
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Scott Weich
- Patrick Keown, MRCPsych, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Orla McBride, PhD, School of Psychology, University of Ulster, County Londonderry, Ulster; Liz Twigg, PhD, Department of Geography, University of Portsmouth, Portsmouth; David Crepaz-Keay, DProf, Mental Health Foundation, London; Eva Cyhlarova, DPhil, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford; Helen Parsons, PhD, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry; Jan Scott, MD, Academic Psychiatry, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne; Kamaldeep Bhui, MD, Centre for Psychiatry, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London; Scott Weich, MD, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Abstract
ObjectiveThis paper reviews the decline in numbers in inpatient psychiatric care in Ireland over the past half century.MethodThe relevant policy publications advocating de-institutilisation have been examined. Change has been monitored through successive census reports of the Medico-social Research Board and the Health Research Board.FindingsIreland has moved from having the highest hospitalisation rate of any western country to a position of equality with other comparable countries in the quantum of inpatient care provided. In the public sector virtually no patients remain in 19th century mental hospitals with acute care being provided in general hospital units. Numbers have also decreased in the private sector but to a lesser degree and acute private care is still delivered in stand-alone psychiatric hospitals.
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Samele C, Urquía N. Psychiatric inpatient care: where do we go from here? Epidemiol Psychiatr Sci 2015; 24:371-5. [PMID: 26220718 PMCID: PMC8367359 DOI: 10.1017/s2045796015000591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/01/2015] [Indexed: 11/07/2022] Open
Abstract
The significant decline in the number of psychiatric hospital beds for more than two decades across Europe has changed the landscape of mental health services. This has rekindled debates about bed shortages and the reasons for variations in the number of inpatient beds, admissions to hospital and length of stay. Analysis of European Union (EU) level data shows that the UK has a relatively low number of admissions to hospital, yet a much higher than average length of stay compared with 12 other EU Member States. Understanding this is difficult, but recent studies shed some further light on the patterns and predictors of admissions and length of stay.
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Affiliation(s)
- C. Samele
- Institute of Mental Health, Nottingham, UK
- Director of Informed Thinking Ltd, London, UK
| | - N. Urquía
- Director of Informed Thinking Ltd, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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