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Understanding increasing rates of psychiatric hospital detentions in England : development and preliminary testing of an explanatory model
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Sheridan Rains, Luke, Weich, Scott, Maddock, Clementine, Smith, Shubulade, Keown, Patrick, Crepaz-Keay, David, Singh, Swaran P., Jones, Rebecca, Kirkbride, James, Millett, Lottie, Lyons, Natasha, Branthonne-Foster, Stella, Johnson, Sonia and Lloyd-Evans, Brynmor (2020) Understanding increasing rates of psychiatric hospital detentions in England : development and preliminary testing of an explanatory model. BJPsych Open, 6 (5). e88. doi:10.1192/bjo.2020.64 ISSN 2056-4724.
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Official URL: https://doi.org/10.1192/bjo.2020.64
Abstract
Background: The steep rise in 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.
Methods: 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 or prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of Austerity measures and reductions in NHS inpatient 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.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Psychiatric hospital patients -- Great Britain, Psychiatric hospital care -- Great Britain, Forensic psychiatry -- Great Britain, Psychiatrists -- Legal status, laws, etc. -- Great Britain, Mental health laws -- Great Britain, Mentally ill -- Commitment and detention -- Great Britain | |||||||||
| Journal or Publication Title: | BJPsych Open | |||||||||
| Publisher: | Royal College of Psychiatrists | |||||||||
| ISSN: | 2056-4724 | |||||||||
| Official Date: | 14 August 2020 | |||||||||
| Dates: |
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| Volume: | 6 | |||||||||
| Number: | 5 | |||||||||
| Article Number: | e88 | |||||||||
| DOI: | 10.1192/bjo.2020.64 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Copyright Holders: | COPYRIGHT: © The Author(s) 2020. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists | |||||||||
| Date of first compliant deposit: | 1 July 2020 | |||||||||
| Date of first compliant Open Access: | 11 September 2020 | |||||||||
| RIOXX Funder/Project Grant: |
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