Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model
BackgroundThe steep rise in the rate of psychiatric hospital detentions in England is poorly understood.AimsTo 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.Meth...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2020-09-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472420000642/type/journal_article |
| _version_ | 1827995670518169600 |
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| author | Luke Sheridan Rains Scott Weich Clementine Maddock Shubulade Smith Patrick Keown David Crepaz-Keay Swaran P. Singh Rebecca Jones James Kirkbride Lottie Millett Natasha Lyons Stella Branthonne-Foster Sonia Johnson Brynmor Lloyd-Evans |
| author_facet | Luke Sheridan Rains Scott Weich Clementine Maddock Shubulade Smith Patrick Keown David Crepaz-Keay Swaran P. Singh Rebecca Jones James Kirkbride Lottie Millett Natasha Lyons Stella Branthonne-Foster Sonia Johnson Brynmor Lloyd-Evans |
| author_sort | Luke Sheridan Rains |
| collection | DOAJ |
| description | BackgroundThe steep rise in the rate of psychiatric hospital detentions in England is poorly understood.AimsTo 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.MethodHypotheses 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.ResultsSeventeen 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 and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers.ConclusionsBetter 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. |
| first_indexed | 2024-04-10T04:58:50Z |
| format | Article |
| id | doaj.art-20201d0971834a1a96074979149944c8 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:58:50Z |
| publishDate | 2020-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-20201d0971834a1a96074979149944c82023-03-09T12:29:04ZengCambridge University PressBJPsych Open2056-47242020-09-01610.1192/bjo.2020.64Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory modelLuke Sheridan Rains0Scott Weich1Clementine Maddock2Shubulade Smith3https://orcid.org/0000-0002-3797-6985Patrick Keown4https://orcid.org/0000-0003-4727-5880David Crepaz-Keay5https://orcid.org/0000-0003-3845-4721Swaran P. Singh6Rebecca Jones7James Kirkbride8https://orcid.org/0000-0003-3401-0824Lottie Millett9Natasha Lyons10https://orcid.org/0000-0003-1635-0681Stella Branthonne-Foster11Sonia Johnson12Brynmor Lloyd-Evans13https://orcid.org/0000-0001-9866-788XDivision of Psychiatry, University College London, UKProfessor, School of Health and Related Research, University of Sheffield, UKSwansea Bay University Health Board, UKBehavioural and Developmental Disorders Directorate, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London; and Department of Forensic and Neurodevelopmental Disorders, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UKNorthumberland Tyne and Wear NHS Foundation Trust, UKMental Health Foundation, London, UKProfessor, Department of Mental Health and Wellbeing, University of Warwick, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKDivision of Psychiatry, University College London, UKProfessor, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, London, UKAssociate Professor, Division of Psychiatry, University College London, UKBackgroundThe steep rise in the rate of psychiatric hospital detentions in England is poorly understood.AimsTo 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.MethodHypotheses 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.ResultsSeventeen 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 and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers.ConclusionsBetter 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.https://www.cambridge.org/core/product/identifier/S2056472420000642/type/journal_articleIn-patient treatmentpsychiatry and lawmental health actdetentionsrisk assessment |
| spellingShingle | Luke Sheridan Rains Scott Weich Clementine Maddock Shubulade Smith Patrick Keown David Crepaz-Keay Swaran P. Singh Rebecca Jones James Kirkbride Lottie Millett Natasha Lyons Stella Branthonne-Foster Sonia Johnson Brynmor Lloyd-Evans Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model BJPsych Open In-patient treatment psychiatry and law mental health act detentions risk assessment |
| title | Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model |
| title_full | Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model |
| title_fullStr | Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model |
| title_full_unstemmed | Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model |
| title_short | Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model |
| title_sort | understanding increasing rates of psychiatric hospital detentions in england development and preliminary testing of an explanatory model |
| topic | In-patient treatment psychiatry and law mental health act detentions risk assessment |
| url | https://www.cambridge.org/core/product/identifier/S2056472420000642/type/journal_article |
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