Variation in compulsory psychiatric inpatient admission in England: a cross-sectional, multilevel analysis

BackgroundRates of compulsory admission have increased in England in recent decades, and this trend is accelerating. Studying variation in rates between people and places can help identify modifiable causes.ObjectivesTo quantify and model variances in the rate of compulsory admission in England at different spatial levels and to assess the extent to which this was explained by characteristics of people and places.DesignCross-sectional analysis using multilevel statistical modelling.SettingEngland, including 98% of Census lower layer super output areas (LSOAs), 95% of primary care trusts (PCTs), 93% of general practices and all 69 NHS providers of specialist mental health services.Participants1,287,730 patients.Main outcome measureThe study outcome was compulsory admission, defined as time spent in an inpatient mental illness bed subject to the Mental Health Act (2007) in 2010/11. We excluded patients detained under sections applying to emergency assessment only (including those in places of safety), guardianship or supervision of community treatment. The control group comprised all other users of specialist mental health services during the same period.Data sourcesThe Mental Health Minimum Data Set (MHMDS). Data on explanatory variables, characterising each of the spatial levels in the data set, were obtained from a wide range of sources, and were linked using MHMDS identifiers.ResultsA total of 3.5% of patients had at least one compulsory admission in 2010/11. Of (unexplained) variance in the null model, 84.5% occurred between individuals. Statistically significant variance occurred between LSOAs [6.7%, 95% confidence interval (CI) 6.2% to 7.2%] and provider trusts (6.9%, 95% CI 4.3% to 9.5%). Variances at these higher levels remained statistically significant even after adjusting for a large number of explanatory variables, which together explained only 10.2% of variance in the study outcome. The number of provider trusts whose observed rate of compulsory admission differed from the model average to a statistically significant extent fell from 45 in the null model to 20 in the fully adjusted model. We found statistically significant associations between compulsory admission and age, gender, ethnicity, local area deprivation and ethnic density. There was a small but statistically significant association between (higher) bed occupancy and compulsory admission, but this was subsequently confounded by other covariates. Adjusting for PCT investment in mental health services did not improve model fit in the fully adjusted models.ConclusionsThis was the largest study of compulsory admissions in England. While 85% of the variance in this outcome occurred between individuals, statistically significant variance (around 7% each) occurred between places (LSOAs) and provider trusts. This higher-level variance in compulsory admission remained largely unchanged even after adjusting for a large number of explanatory variables. We were constrained by data available to us, and therefore our results must be interpreted with caution. We were also unable to consider many hypotheses suggested by the service users, carers and professionals who we consulted. There is an imperative to develop and evaluate interventions to reduce compulsory admission rates. This requires further research to extend our understanding of the reasons why these rates remain so high.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Distress and impaired functioning, coping mechanisms and barriers to access mental health services among Syrian refugees and Jordanian adults after eight years of Syrian crisis: a cross-sectional study (Preprint)

10.2196/preprints.29797 ◽

2021 ◽

Author(s):

Yousef Khader ◽

Ahmad Bawaneh ◽

Zaid Al-Hamdan

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Significant Proportion ◽

Cross Sectional Study ◽

Coping Mechanisms ◽

Syrian Refugees ◽

Sectional Study ◽

Cross Sectional ◽

Barriers To Access

BACKGROUND The Syrian conflict started in 2011 and resulted ever since in a large displacement of Syrians. Conflict-related violence coupled with displacement related stressors such as poverty, poor access to health services, loss of family support and discrimination had a significant impact on the mental health and psychosocial wellbeing of Syrian refugee OBJECTIVE This study aimed to identify the perceived symptoms of severe distress and impaired functioning, identify coping mechanisms and identify the barriers to access mental health services among Syrian refugees and Jordanian adults. METHODS This cross-sectional study study took place in 14 randomly selected sites in Jordan where Syrian refugees are concentered and from Za’tari refugee camp. A toolkit for humanitarian settings was used for data collection. RESULTS Of the 1424 participants, 43.4% had distress; 38.9% among host population, 57.0% among refugees in urban communities, and 23.0% among refugees in camp (p <0.005). Overall, finding comfort in faith and spiritual beliefs was the most common coping mechanism reported by those who perceived to be experiencing distress. CONCLUSIONS A significant proportion of Syrian refugees had distress symptoms. It is recommended to incorporate mental health services into broad-based community settings, such as schools, primary prevention or case management programs.

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Mental health services for war-affected children

The British Journal of Psychiatry ◽

10.1192/02-633 ◽

2003 ◽

Vol 183 (6) ◽

pp. 540-546

Author(s):

Lynne Jones ◽

Alban Rrustemi ◽

Mimoza Shahini ◽

Aferdita Uka

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Learning Disability ◽

Stress Reactions ◽

Educational Role ◽

Number Of Patients ◽

Wide Range ◽

Adolescent Mental Health Service ◽

Local Actors

BackgroundIn war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions.AimsTo describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented.MethodData were collected on 559 patients over 2 years, including their referring problems and diagnoses.ResultsStress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to atraumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories.ConclusionsMental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in ‘depathologising’ normative responses.

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Mental health services for war-affected children

The British Journal of Psychiatry ◽

10.1192/bjp.183.6.540 ◽

2003 ◽

Vol 183 (06) ◽

pp. 540-546 ◽

Cited By ~ 38

Author(s):

Lynne Jones ◽

Alban Rrustemi ◽

Mimoza Shahini ◽

Aferdita Uka

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Learning Disability ◽

Stress Reactions ◽

Educational Role ◽

Number Of Patients ◽

Wide Range ◽

Adolescent Mental Health Service ◽

Local Actors

Background In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions. Aims To describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented. Method Data were collected on 559 patients over 2 years, including their referring problems and diagnoses. Results Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to atraumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories. Conclusions Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in ‘depathologising’ normative responses.

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Reducing aggression and improving offending outcomes in youth with conduct disorder, results of a systematic review

BJPsych Open ◽

10.1192/bjo.2021.719 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S270-S270

Author(s):

Craig McEwan ◽

Lauren Dunn ◽

Jake Harvey

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Conduct Disorder ◽

Antisocial Behaviour ◽

Target Population ◽

Evidence Base ◽

Data Set ◽

Effective Prevention ◽

Offending Behaviour

AimsThe aim of this literature review was to determine what interventions are effective in reducing aggression and offending behaviour in under 18's with conduct disorder.Null hypothesis: There is no difference in aggression or offending behaviour in under 18's with conduct problems in spite of interventions offeredBackgroundMental health services for children and adolescents who are aggressive or who have come into contact with the Youth Justice System are sparse and often under resourced. Conduct disorder (CD) is one of the most frequently diagnosed conditions in adolescents, particularly in young offenders (Kenny et al 2007). The most effective prevention programs for youth at risk of persistent delinquency has previously been found to be a multi model program focussing on the family context. However, this has not taken in to consideration the extent and prevalence of mental disorder, including conduct disorder, within the target population.MethodA systematic literature search was undertaken on medline and psychoinfo between January and December 2018. Identified papers were then screened by two independent researchers against pre-agreed inclusion and exclusion criteria. Relevant papers were assessed for bias and results summarised.ResultFrom an initial data set of 526 papers, 9 were included for review. 4 focussed on psychopharmacology (1 aripiprazole, 1 risperidone, 1 risperidone vs clozapine, 1 clozapine), 1 family centred feedback, 1 Mode Deactivation Therapy and 3 were multi modal (combinations of Mode Deactivation Therapy, Stop Now and Act Programme, CBT, Didactic sessions, 1:1 counselling). None of the multi-modal interventions were standardised or comparable to each other. End points varied from 8 weeks (aripiprazole) to 15 months (multimodal SNAP programme). Settings varied from community programmes to secure inpatient settings. Whilst one risperidone study reported it to be effective in reducing aggression, it was not significant. One SNAP (multimodal) programme failed to show significant effect. All other 7 interventions, across various methods, demonstrated significant reductions in aggression, violence or other antisocial behaviour.ConclusionFew papers were identified that assessed interventions for youth with conduct disorder. The papers that were identified were significantly heterogeneous in their intervention, sample selection, methodology and outcome measures. Unfortunately, this leads to an inability to compare any interventions for this demographic. Despite the rise in Forensic Child and Adolescent Mental Health Services, there is a weak and poorly understood evidence base for supporting and managing young people with conduct disorder.

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Nonmental Healthcare Professionals’ Attitudes Toward Mental Health Services in Asir Region, KSA

Journal of Psychiatry & Mental Disorders ◽

10.26420/jpsychiatrymentaldisord.2021.1046 ◽

2021 ◽

Vol 6 (4) ◽

Author(s):

Alsubaie SS ◽

◽

Al-Hufayyan RS ◽

Mohammed MS ◽

Alsufyani AH ◽

...

Keyword(s):

Mental Health ◽

Saudi Arabia ◽

Mental Health Services ◽

Health Services ◽

Work Experience ◽

Future Research ◽

P Value ◽

Kingdom Of Saudi Arabia ◽

Cross Sectional ◽

Asir Region

Objectives: Most patients who visit other clinics are surprised when they referred to psychiatric clinics, which may be related to the social stigma of mental illness or nonmental health professionals’ (NMHPs) negative attitude toward psychiatric illness. The study aimed to assess attitudes toward mental health services among NMHPs in Asir region, Kingdom of Saudi Arabia (KSA), and to correlate the results with different variables. Methods: We conducted a cross-sectional study among NMHPs (n=358) in Asir region of the kingdom of Saudi Arabia by using an electronic questionnaire through WhatsApp application. Results: Young age, female gender, single marital status, did not ever had known or shared in giving care to a mentally ill person, work experience less than 10 years, nursing specialty, and holding diploma degree represented the significant statistical correlation with negative attitudes toward mental health services scale (p-value = <0.001; 0.01; 0.003; 0.02; <0.001; 0.02 and <0.001, respectively). Conclusion: This study demonstrates positive attitude toward mental health services among NMHPs. There is need for better educational measures and more training courses at the undergraduate level of NMHPs in order to improve such attitude. Future research could investigate the outcomes of these measures and courses.

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Distance to health services and treatment-seeking for depressive symptoms in rural India: a repeated cross-sectional study

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579601900088x ◽

2020 ◽

Vol 29 ◽

Author(s):

T. Roberts ◽

S. Shiode ◽

C. Grundy ◽

V. Patel ◽

R. Shidhaye ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Public Mental Health ◽

Travel Distance ◽

Rural India ◽

Treatment Seeking ◽

Depression Treatment ◽

Treatment Provider ◽

Cross Sectional

Abstract Aims Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. Methods We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. Results We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98–1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. Conclusions Geographic accessibility – as measured by travel distance – is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.

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Mental health services in Germany

Psychiatric Bulletin ◽

10.1192/s0955603600106658 ◽

1992 ◽

Vol 16 (01) ◽

pp. 40-42 ◽

Cited By ~ 1

Author(s):

Christine M. Tyrie

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

West Germany ◽

Wide Range ◽

Professional Workers

On a recent study trip I was able to examine approaches to health care, in particular, mental health services in what was West Germany. I visited a range of facilities and met a wide range of professional workers.

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Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

Psychological Medicine ◽

10.1017/s0033291713002122 ◽

2013 ◽

Vol 44 (8) ◽

pp. 1615-1624 ◽

Cited By ~ 73

Author(s):

I. Kelleher ◽

N. Devlin ◽

J. T. W. Wigman ◽

A. Kehoe ◽

A. Murtagh ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Suicidal Behaviour ◽

Health Clinic ◽

Psychotic Experiences ◽

Global Functioning ◽

Community Based Research ◽

Wide Range

BackgroundRecent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour.MethodThe investigation was a clinical case–clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services.ResultsPsychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59–49.83], anxiety disorder (OR 15.4, 95% CI 1.85–127.94) or behavioural disorder (OR 3.13, 95% CI 1.11–8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences.ConclusionsPsychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

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