Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis

Scott Weich, Orla McBride, Liz Twigg, Craig Duncan, Patrick Keown, David Crepaz-Keay, Eva Cyhlarova, Helen Parsons, Jan Scott, Kamaldeep Bhui

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background The increasing rate of compulsory admission to psychiatric in-patient beds in England is concerning. Studying variation between places and services could be key to identifying targets for interventions to reverse this. We modelled spatial variation in compulsory admissions in England using national patient-level data, and quantified the extent to which patient, local area and service setting characteristics accounted for this variation. MethodsCross-sectional, multilevel analysis of the 2010/11 Mental Health Minimum Data Set (MHMDS). Data were available for 1,238,188 patients, covering 64 NHS Provider Trusts (93%) and 31,865 Census Lower Super Output Areas (LSOAs) (98%). Primary outcome was compulsory admission to a mental illness bed, compared with people admitted voluntarily or receiving only community-based care. Outcomes7∙5% and 5∙6% of the variance in compulsory admission occurred at LSOA- and Provider Trust-levels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than White patients (OR 2∙94, 95% CI 2∙90-2∙98). Compulsory admission was greater in more deprived areas (OR 1∙22, 95% CI 1∙18-1∙27) and in areas with more non-white residents (OR 1∙51, 95% CI 1∙43-1∙59), after adjusting for confounders.InterpretationCompulsory psychiatric in-patient admission varies significantly between local areas and services, independent of patient, area and service characteristics. Compulsory admission rates appear to reflect local factors, especially socio-economic and ethnic population composition. Understanding how these condition access to and use of mental health care is likely to be important for developing interventions to reduce compulsion.
LanguageEnglish
Pages619-626
JournalLancet Psychiatry
Volume4
Issue number8
Early online date21 Jun 2017
DOIs
Publication statusPublished - 31 Aug 2017

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Multilevel Analysis
Patient Admission
England
Psychiatry
Mental Health
Censuses
Economics
Delivery of Health Care

Keywords

  • psychiatry
  • data linkage
  • NHS administrative data
  • Mental Health Act

Cite this

Weich, Scott ; McBride, Orla ; Twigg, Liz ; Duncan, Craig ; Keown, Patrick ; Crepaz-Keay, David ; Cyhlarova, Eva ; Parsons, Helen ; Scott, Jan ; Bhui, Kamaldeep. / Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis. In: Lancet Psychiatry. 2017 ; Vol. 4, No. 8. pp. 619-626.
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title = "Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis",
abstract = "Background The increasing rate of compulsory admission to psychiatric in-patient beds in England is concerning. Studying variation between places and services could be key to identifying targets for interventions to reverse this. We modelled spatial variation in compulsory admissions in England using national patient-level data, and quantified the extent to which patient, local area and service setting characteristics accounted for this variation. MethodsCross-sectional, multilevel analysis of the 2010/11 Mental Health Minimum Data Set (MHMDS). Data were available for 1,238,188 patients, covering 64 NHS Provider Trusts (93{\%}) and 31,865 Census Lower Super Output Areas (LSOAs) (98{\%}). Primary outcome was compulsory admission to a mental illness bed, compared with people admitted voluntarily or receiving only community-based care. Outcomes7∙5{\%} and 5∙6{\%} of the variance in compulsory admission occurred at LSOA- and Provider Trust-levels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than White patients (OR 2∙94, 95{\%} CI 2∙90-2∙98). Compulsory admission was greater in more deprived areas (OR 1∙22, 95{\%} CI 1∙18-1∙27) and in areas with more non-white residents (OR 1∙51, 95{\%} CI 1∙43-1∙59), after adjusting for confounders.InterpretationCompulsory psychiatric in-patient admission varies significantly between local areas and services, independent of patient, area and service characteristics. Compulsory admission rates appear to reflect local factors, especially socio-economic and ethnic population composition. Understanding how these condition access to and use of mental health care is likely to be important for developing interventions to reduce compulsion.",
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Weich, S, McBride, O, Twigg, L, Duncan, C, Keown, P, Crepaz-Keay, D, Cyhlarova, E, Parsons, H, Scott, J & Bhui, K 2017, 'Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis', Lancet Psychiatry, vol. 4, no. 8, pp. 619-626. https://doi.org/10.1016/S2215-0366(17)30207-9

Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis. / Weich, Scott; McBride, Orla; Twigg, Liz; Duncan, Craig; Keown, Patrick; Crepaz-Keay, David; Cyhlarova, Eva; Parsons, Helen; Scott, Jan; Bhui, Kamaldeep.

In: Lancet Psychiatry, Vol. 4, No. 8, 31.08.2017, p. 619-626.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variation in Compulsory Psychiatric In-Patient Admission in England: a Cross-Classified, Multilevel Analysis

AU - Weich, Scott

AU - McBride, Orla

AU - Twigg, Liz

AU - Duncan, Craig

AU - Keown, Patrick

AU - Crepaz-Keay, David

AU - Cyhlarova, Eva

AU - Parsons, Helen

AU - Scott, Jan

AU - Bhui, Kamaldeep

N1 - UIR Compliant - evidence uploaded to other files

PY - 2017/8/31

Y1 - 2017/8/31

N2 - Background The increasing rate of compulsory admission to psychiatric in-patient beds in England is concerning. Studying variation between places and services could be key to identifying targets for interventions to reverse this. We modelled spatial variation in compulsory admissions in England using national patient-level data, and quantified the extent to which patient, local area and service setting characteristics accounted for this variation. MethodsCross-sectional, multilevel analysis of the 2010/11 Mental Health Minimum Data Set (MHMDS). Data were available for 1,238,188 patients, covering 64 NHS Provider Trusts (93%) and 31,865 Census Lower Super Output Areas (LSOAs) (98%). Primary outcome was compulsory admission to a mental illness bed, compared with people admitted voluntarily or receiving only community-based care. Outcomes7∙5% and 5∙6% of the variance in compulsory admission occurred at LSOA- and Provider Trust-levels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than White patients (OR 2∙94, 95% CI 2∙90-2∙98). Compulsory admission was greater in more deprived areas (OR 1∙22, 95% CI 1∙18-1∙27) and in areas with more non-white residents (OR 1∙51, 95% CI 1∙43-1∙59), after adjusting for confounders.InterpretationCompulsory psychiatric in-patient admission varies significantly between local areas and services, independent of patient, area and service characteristics. Compulsory admission rates appear to reflect local factors, especially socio-economic and ethnic population composition. Understanding how these condition access to and use of mental health care is likely to be important for developing interventions to reduce compulsion.

AB - Background The increasing rate of compulsory admission to psychiatric in-patient beds in England is concerning. Studying variation between places and services could be key to identifying targets for interventions to reverse this. We modelled spatial variation in compulsory admissions in England using national patient-level data, and quantified the extent to which patient, local area and service setting characteristics accounted for this variation. MethodsCross-sectional, multilevel analysis of the 2010/11 Mental Health Minimum Data Set (MHMDS). Data were available for 1,238,188 patients, covering 64 NHS Provider Trusts (93%) and 31,865 Census Lower Super Output Areas (LSOAs) (98%). Primary outcome was compulsory admission to a mental illness bed, compared with people admitted voluntarily or receiving only community-based care. Outcomes7∙5% and 5∙6% of the variance in compulsory admission occurred at LSOA- and Provider Trust-levels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than White patients (OR 2∙94, 95% CI 2∙90-2∙98). Compulsory admission was greater in more deprived areas (OR 1∙22, 95% CI 1∙18-1∙27) and in areas with more non-white residents (OR 1∙51, 95% CI 1∙43-1∙59), after adjusting for confounders.InterpretationCompulsory psychiatric in-patient admission varies significantly between local areas and services, independent of patient, area and service characteristics. Compulsory admission rates appear to reflect local factors, especially socio-economic and ethnic population composition. Understanding how these condition access to and use of mental health care is likely to be important for developing interventions to reduce compulsion.

KW - psychiatry

KW - data linkage

KW - NHS administrative data

KW - Mental Health Act

U2 - 10.1016/S2215-0366(17)30207-9

DO - 10.1016/S2215-0366(17)30207-9

M3 - Article

VL - 4

SP - 619

EP - 626

JO - Lancet Psychiatry

T2 - Lancet Psychiatry

JF - Lancet Psychiatry

SN - 2215-0366

IS - 8

ER -