The move to community-based mental health services in England has paradoxically led to an increase in the number of people being detained in hospital each year, and in particular an inexorable rise in involuntary admissions. This is likely to be partly because of improved case finding with an increased focus on treatment and risk management, and partly because of changes in legislation. An increasing proportion of this government-funded care is being provided by private hospitals.Declaration of interestNone.

Mental health surveys by questionnaire are frequently unclear as to the theory which inspires them and as to the use to which their data are to be put. In this book, although neither theory nor application are made fully explicit, there are reasonably clear pointers to both. The target is 'psy chiatric illness' -this being defined as that type of clinical picture which a British psy chiatrist would consider to justify his atten tion -and the immediate aim is to assist general medical practitioners to identify patients with such illness -perhaps, but not necessarily, with a view to obtaining psy chiatric advice.The questionnaire is intended to assist in the identification of new cases of this type (excluding the psychoses), and the eventual goal appears to be the plotting of their epidemiology in general medical prac tice settings. Since the questionnaire is not intended to identify persons with longestablished disorders or those who tend not to seek medical help, the research and its resultant questionnaire have quite limited goals. Also, the individuals identified by it are not all alleged to require specialist psy chiatric care (in fact, most appear to lose their symptoms without this) and it is im plicitly recognized that the, symptoms may have their origin in other medical or social problems about which the psychiatrist may

BackgroundThe Mental Health Act in England and Wales allows for two types of detention in hospital: civil and forensic detentions. An association between the closure of mental illness beds and a rise in civil detentions has been reported.AimsTo examine changes in the rate of court orders and transfer from prison to hospital for treatment, and explore associations with civil involuntary detentions, psychiatric bed numbers and the prison population.MethodSecondary analysis of routinely collected data with lagged time series analysis. We focused on two main types of forensic detentions in National Health Service (NHS) hospitals and private units: prison transfers and court treatment orders in England from 1984 to 2016. NHS bed numbers only were available.ResultsThere was an association between the number of psychiatric beds and the number of prison transfers. This was strongest at a time lag of 2 years with the change in psychiatric beds occurring first. There was an association between the rate of civil detentions and the rate of court orders. This was strongest at a time lag of 3 years. Linear regression indicated that 135 fewer psychiatric beds were associated with one additional transfer from prison to hospital; and as the rate of civil detentions increased by 72, the rate of court treatment orders fell by one.ConclusionsThe closure of psychiatric beds was associated with an increase in transfers from prison to hospital for treatment. The increase in civil detentions was associated with a reduction in the rate of courts detaining to hospital individuals who had offended.Declaration of interestNone.

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