The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use

Keown, Patrick; Holloway, Frank; Kuipers, Elizabeth

doi:10.1007/s00127-005-0842-0

Cited by 21 publications

(17 citation statements)

References 29 publications

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“…Additionally, only principal diagnoses, not comorbid illnesses, were analysed. In previous studies, the influence of psychiatric comorbidity on patients with mental illnesses was inconsistent [18,69,70], but comorbid physical illnesses prolonged LOS of psychiatric patients [71][72][73]. In the present study, however, preliminary analyses showed that comorbidities differently affected to each principal diagnosis.…”

Section: Limitationscontrasting

confidence: 75%

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

Chung¹,

Oh²,

Suh³

et al. 2010

Health Policy

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Section: Limitationscontrasting

confidence: 75%

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

Chung¹,

Oh²,

Suh³

et al. 2010

Health Policy

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“…Ethnicity has been found to have no effect on LOS [11, 29], though Tulloch et al [11] found a significant effect of ethnicity that was found not to be independent of other effects. In the present study, Asian or Asian British, Black or Black British, and Mixed background ethnicity categories were associated with a longer LOS than White or White British recorded ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Length of Stay in Psychiatric Inpatient Services in London, UK

et al. 2017

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The purpose of this research was to identify factors associated with lengthy stays in psychiatric hospital in a UK mental health trust. A multiple regression using a multiple imputation method to deal with missing data was performed on inpatient admissions data over a four-year period for 7653 individuals. Factors associated with a longer length of stay included gender (being male), ethnicity (being Asian/Asian British, Black/Black British, or having a mixed background compared to being White/White British), accommodation status (being homeless, or in accommodation with support), primary diagnostic group of psychosis (F20-29), and number of care coordinators. Marital status was not found to be associated with length of stay in this sample. Length of stay is likely to be multifactorially determined, and more similar studies examining factors associated with length of hospital stay are needed to understand the operation of psychiatric services.

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“…116,117 Many previous studies of the excess detention of BME patients have been from London, which may not be representative of other areas of the UK. A large study of 22 psychiatric hospitals in England found no association between ethnicity and patient perceptions of coercion at admission or during the first 4 weeks of inpatient stay.…”

Section: Discussionmentioning

confidence: 99%

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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The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use

Cited by 21 publications

References 29 publications

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

Determinants of length of stay for psychiatric inpatients: Analysis of a national database covering the entire Korean elderly population

Factors Associated with Length of Stay in Psychiatric Inpatient Services in London, UK

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

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