A comparison of in-patient mental health rehabilitation services provided by the NHS and independent sector in England: patient and service characteristics

Background In-patient mental health rehabilitation services provide specialist care to adults with complex psychosis. In England, there are more than 350 such services, half provided by the National Health Service (NHS) and half by the independent sector. Aims To investigate whether NHS and independent sector in-patient mental health rehabilitation services differ. Method We recruited a random sample of NHS and independent sector services across England. We collected cross-sectional data regarding service and patient characteristics through interviews with patients, clinicians and managers, and from healthcare record reviews. Results We recruited 411 patients from 48 NHS services and 172 patients from 20 independent sector services. Service characteristics, including standardised quality scores, were similar. Most patients had a diagnosis of schizophrenia (NHS n = 237, 57.7%; independent sector n = 99, 57.6%) or schizoaffective disorder (NHS n = 88, 21.4%; independent sector n = 32, 18.6%). More than half had at least one comorbid condition, but more independent sector patients had at least two (NHS 131 of 411, 31.9%; independent sector 80 of 172, 46.5%; P = 0.001). Current admissions were twice as long for independent sector patients (NHS mean 1.2 years [s.d. 1.5]; independent sector mean 2.4 years [s.d. 2.8]). Standardised ratings of patients' quality of life, autonomy, time use, satisfaction with care, social and everyday functioning, and challenging behaviours were similar. However, independent sector patients had more needs (NHS mean 6.5 [s.d. 3.2]; independent sector mean 7.9 [s.d. 3.9]; P < 0.001) and more had a history of fire setting (NHS 32, 7.9%; independent sector 28, 17.2%; P = 0.001). Conclusions Both NHS and independent sector in-patient rehabilitation services support people with complex psychosis, but independent sector patients may have more complex conditions, which could explain their longer admissions.