Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996

Hotopf, Matthew; Wall, Sharon; Buchanan, Alec; Wessely, Simon; Churchill, Rachel

doi:10.1192/bjp.176.5.479

Cited by 48 publications

(35 citation statements)

References 7 publications

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“…In the european and worldwide clinical trials, the prevalence of involuntary hospitalization ranges from 3.2% and 42% (Zinkler & Priebe 2002;Salize & Dressing 2004;Zhou et al 2015;Lastly, Rittmannsberger et al 2004) conducted a multicentre study involving twenty-four European countries and reported a prevalence of involuntary hospitalizations corresponding to 11.4%, evaluated in a single day. Prevalence and criteria of involuntary admissions change widely across different countries; some possible explanations refer to differences among legislature (Riecher-Rossler & Rossler 1993;Zinkler & Priebe 2002;Salize & Dressing 2004), organization of the mental health services (Lelliott & Audini 2003), culture and ethnicity (Riecher-Rossler & Rossler, 1993;, professional ethic (Zinkler & Priebe 2002;Zhou et al 2015) and social pressures on psychiatrists (Hotopf et al 2000). We found statistically significant differences in terms of socio-demographic and clinical features, comparing involuntary versus voluntary hospitalizations.…”

Section: Discussionmentioning

confidence: 68%

Involuntary admissions in Italy: the impact of seasonality

Aguglia

Moncalvo

Solia

et al. 2016

International Journal of Psychiatry in Clinical Practice

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Objective: The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months. Methods: All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected. Results: Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons. Conclusions: Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients.

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Section: Discussionmentioning

confidence: 68%

Involuntary admissions in Italy: the impact of seasonality

Aguglia

Moncalvo

Solia

et al. 2016

International Journal of Psychiatry in Clinical Practice

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“…112 Even when clinicians' judgements are consistent with the law, unexplained variations in decision-making exist, influenced by factors such as clinician characteristics, local service provision, community support for patients, patient ethnicity, age and education and attitudes to mental health. 111,[113][114][115] Although the exact reasons for increasing detention rates have not been delineated, our findings suggest one possibility: the increasing risk aversion in clinical practice. Clinicians in our study highlighted how risk assessment and management is increasingly the focus of their concern in MHA assessments.…”

Section: Discussionmentioning

confidence: 75%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…In 1996, over 26 000 people in England with mental disorders were deprived of their liberty and detained in hospital without their consent under the Mental Health Act 1983 (Hotopf et al, 2000). Despite the rapidly increasing use of existing legislation, there has been little research into the operation of the Act and the various measures it incorporates, to ensure against unjustified detention in hospital (Wall et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

In relative danger? The outcome of patients discharged by their nearest relative from sections 2 and 3 of the Mental Health Act

Shaw¹,

Hotopf²,

Davies³

2003

Psychiatr. bull.

Self Cite

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Aims and Method Among the proposed changes in the current review of mental health legislation in England and Wales is the abolition of the right of the nearest relative to discharge patients from assessment and treatment orders (Sections 2 and 3 of the Mental Health Act 1983). We aimed to determine the clinical outcome of patients whose nearest relative applies for discharge. A retrospective case–control cohort study in a south London NHS Trust of 51 patients successfully discharged by their nearest relative and 33 patients whose nearest-relative applications were blocked by the treating psychiatrist on the grounds of ‘dangerousness'. Results Patients discharged from section by their nearest relative did not differ significantly from controls in all the measures of clinical outcome examined. Clinical Implications This study suggests that discharges by the nearest relative against psychiatric advice are not associated with a poor clinical outcome.

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Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996

Abstract: Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.

Cited by 48 publications

References 7 publications

Involuntary admissions in Italy: the impact of seasonality

Involuntary admissions in Italy: the impact of seasonality

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

In relative danger? The outcome of patients discharged by their nearest relative from sections 2 and 3 of the Mental Health Act

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