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The Lancet Psychiatry publication

Findings from a National Institute of Health Research (NIHR) Health Services and Delivery Research (HS&DR) funded project findings published in the prestigious The Lancet Psychiatry journal.

This research publication reports on findings from the English National Study of Compulsory Admissions (ENSCA), a multi-institution project lead by the University of Warwick, with collaborators at Ulster University, University of Portsmouth, Newcastle University, Queen Mary University of London, and the Mental Health Foundation.

Dr Orla McBride (Psychology Research Institute), second lead author of the paper, explained: “Research indicates that the rate of compulsory admission to psychiatric inpatient beds in England has been increasing in recent years at an alarming rate.  There were around 63,000 compulsory admissions in 2015/16, a 9% increase on the previous year and an increase of around 43% since the introduction of the 2007 Mental Health Act.  This trend is concerning to service users, clinicians, regulators and policy makers, particularly since compulsory treatment is stigmatising and may hamper engagement with services.

There is evidence that the use of compulsory admission varies between geographical regions and services across England.  The aim of the paper was to analyse routinely collected NHS data of secondary mental health service use to identify where this variation may be occurring, and to explain whether any of the variation in compulsory admission use could be explained by patient, area, or NHS-Trust level characteristics.  Information of this nature is important for identifying targets for intervention to reverse the increase trend of compulsory admission.

The study demonstrated that patient-level factors (e.g. age, sex, and ethnicity) explained 8∙0% of the total variance in risk of being compulsorily admitted.  Black patients were almost three times more likely to be admitted compulsorily than White patients. Area-level characteristics (e.g. high levels of deprivation) and NHS Provider Trusts factors (e.g. quality of community mental health services) were estimated as explaining only a further 2∙2% of this variance.  In total, therefore, our results indicated that just over 10% of the total variance in compulsory admission could be explained by the data available.

Our study highlighted that most of the variance in compulsory admission remains unexplained, even after adjusting for a large number of patient, local-area and service-setting characteristics.  The most likely explanation was the absence of data on key variables, including: diagnosis and illness severity, previous history of admission and/or compulsion, engagement with services, social isolation, and drug and alcohol use (individual-level); availability of adequate housing, social care and other support services (area-level); and bed pressures, crisis intervention response times and local service configuration and quality (NHS Trust-level).  Nevertheless, our findings suggest that compulsory admission rates are not uniform, and may reflect local factors, such as the challenges of delivering home-based crisis care in areas with high levels of socio-economic deprivation.”

A copy of the published paper is available here, along with an accompanying podcast.

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