Trends in inpatient care for psychiatric disorders in NHS hospitals across England, 1998/99–2019/20: an observational time series analysis

Abstract

Purpose It is unclear how hospitals are responding to the mental health needs of the population in England, against a backdrop of diminishing resources. We aimed to document patterns in hospital activity by psychiatric disorder and how these have changed over the last 22 years. Methods In this observational time series analysis, we used routinely collected data on all NHS hospitals in England from 1998/99 to 2019/20. Trends in hospital admissions and bed days for psychiatric disorders were smoothed using negative binomial regression models with year as the exposure and rates (per 1000 person-years) as the outcome. When linear trends were not appropriate, we fitted segmented negative binomial regression models with one change-point. We stratified by gender and age group [children (0–14 years); adults (15 years +)]. Results Hospital admission rates and bed days for all psychiatric disorders decreased by 28.4 and 38.3%, respectively. Trends were not uniform across psychiatric disorders or age groups. Admission rates mainly decreased over time, except for anxiety and eating disorders which doubled over the 22-year period, significantly increasing by 2.9% (AAPC = 2.88; 95% CI: 2.61–3.16; p < 0.001) and 3.4% (AAPC = 3.44; 95% CI: 3.04–3.85; p < 0.001) each year. Inpatient hospital activity among children showed more increasing and pronounced trends than adults, including an increase of 212.9% for depression, despite a 63.8% reduction for adults with depression during the same period. Conclusion In the last 22 years, there have been overall reductions in hospital activity for psychiatric disorders. However, some disorders showed pronounced increases, pointing to areas of growing need for inpatient psychiatric care, especially among children.

Changes in major psychiatric disorders in children and adolescents from 2001 to 2020: A retrospective single-center study

“…Length of hospitalization did not show a significant change with time, which is inconsistent with previous reports ( 12 , 16 , 20 ); previous studies pointed out that the hospitalization duration was shortened because of the use of long-acting formulations of atypical antipsychotics, which are also currently widely used in our center; however, long-acting formulations are not widely prescribed to pediatric patients. The application of long-acting injections for the treatment of SCZ was recommended in the 2015 Chinese expert consensus report ( 21 ); however, a study conducted in 2020 on the application pattern of long-acting injections in SCZ in Asia reported that the application rate of long-acting injections in China is still low, at about 0.66% ( 22 ).…”

“…This trend was reported in many studies that were not age-restricted ( 13 – 15 ). However, in a UK study ( 16 ), it was noted that only the prevalence rates of anxiety and eating disorders increased and those of all other psychiatric disorders decreased in the unrestricted age context. However, for children and adolescents, hospitalization for DD continued to increase by 5.6% between 1998 and 2019.…”

The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

“…The increasing demand for inpatient admissions 11 may indicate that ACEDS are unable to deliver timely evidence-based therapies to prevent patients from deteriorating severely. NHSE Digital 12 reported a fourfold rise in hospital admissions with primary or secondary eating disorder diagnoses between 2007/8 and 2020/21 (~70% are adults).…”

Intensive community and home-based treatments for eating disorders: a scoping review study protocol

“… 13–15 For instance, in England hospital admissions for EDs doubled between 1998 and 2020 while admissions for other severe mental disorders decreased. 16 This situation appears to have been further exacerbated by the ongoing COVID-19 pandemic. Internationally, research has indicated a rise in new ED presentations, increases in symptom severity and high levels of deterioration, relapse and comorbidities in those with established EDs.…”