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Our new paper looks at why rates of involuntary hospitalisation are rising. It was conducted by the @MentalHealthPRU for the #MHAReview in 2018. We were interested in whether there have been changes in structural factors that could (at least in part) explain this rise.
We explored 17 hypotheses related to social, service, legal, and data-quality factors. These included: 1) Increased social and economic hardship; 2) Increased drug and alcohol use; 3) Demographic change (increased numbers of those at risk of detention);
4) Increasing rates of mental illness; 5) Reduced informal social support; 6) Reduced availability and quality of community mental health services; 7) Reduced availability of alternatives to admission; 8) Reduced quality and/or responsiveness of crisis services;
9) Reduced in-patient bed capacity; 10) Less continuity of care at MHA assessments; 11) Greater aversion to risk among mental health professionals; 12) Changes in prescribing practice; 13) Changes in legal and clinical practice in respect of capacity;
14) Introduction of CTOs (and earlier discharge); 15) Police more likely to bring people to a health-based place of safety; 16) Better data reporting in recent years; 17) Increase in transfers between hospitals during admission leads to double-counting
Our hypotheses related to changes in societal, service-related, and legal factors were best supported by the evidence. Changes in legal approaches to safeguarding the rights of patients who lack decision-making capacity are a probable major contributor to the rise in detentions.
Evidence for other factors was more equivocal, however. We some evidence that rising levels of mental illness and demographic change in the population may both contribute. MH services and the police may be getting better at identifying people who meet criteria for detention
Meanwhile, in some community mental healthcare settings, increasingly stretched resources may reduce the availability and intensity of the preventive support that can be provided to patients to avert relapse or subsequent detention.
However, while we were able to explore these hypotheses to some degree, evidence was often sparse and equivocal. Better quality evidence is needed to provide clearer answers to this important topic.
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