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Abstract

Background
Compulsory admission rates under the Mental Health Act (MHA) have been on the rise for many years despite representing a costly and coercive approach to psychiatric care. There is therefore an urgent need to minimise compulsory admission rates using interventions based on known risk factors for detention. However, risk factors in the MHA assessment process have been under-researched.


Methods
A mixed methods service evaluation was conducted in one inner London NHS Trust. A retrospective cohort study used routinely collected assessment records to model potential risk factors for detention. Local assessors were interviewed to explore factors that might help or hinder detention minimisation.


Main findings
Assessments were less likely to result in detention when professionals other than the assessing team were in attendance, although this association weakened after adjusting for potential confounders. Interviewed assessors identified factors that could contribute to detention minimisation in the assessment process, in general service provision, and in wider society.


Conclusion
Some local assessment processes could contribute to minimising detention rates, such as community team participation in assessments. Challenges posed by limited resources and community and inpatient care were particularly evident. Consideration of these might also help reduce detentions.

Background: Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion. Aims: (1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness. Method: Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations. Results: About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age ( p = .008), lack of higher education ( p < .001), more previous admissions ( p = .005), severity of current symptoms and greater experienced stigma ( p = .006) and anticipated stigma ( p = .035). Greater social inclusion was associated with better quality of life ( p < .001) and less loneliness ( p < .001). Conclusions: Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people's social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

BACKGROUND: Individuals with severe mental health problems are at risk of social exclusion, which may complicate their recovery. Mental health and social care staff have, until now, had no valid or reliable way of assessing their clients' social inclusion. The Social Inclusion Questionnaire User Experience (SInQUE) was developed to address this. It assesses five domains: social integration; productivity; consumption; access to services; and political engagement, in the year prior to first psychiatric admission (T1) and the year prior to interview (T2) from which a total score at each time point can be calculated. AIMS: To establish the validity, reliability, and acceptability of the SInQUE in individuals with a broad range of psychiatric diagnoses receiving care from community mental health services and its utility for mental health staff. METHOD: Participants were 192 mental health service users with psychosis, personality disorder, or common mental disorder (e.g., depression, anxiety) who completed the SInQUE alongside other validated outcome measures. Test–retest reliability was assessed in a sub-sample of 30 participants and inter-rater reliability was assessed in 11 participants. SInQUE ratings of 28 participants were compared with those of a sibling with no experience of mental illness to account for shared socio-cultural factors. Acceptability and utility of the tool were assessed using completion rates and focus groups with staff. RESULTS: The SInQUE demonstrated acceptable convergent validity. The total score and the Social Integration domain score were strongly correlated with quality of life, both in the full sample and in the three diagnostic groups. Discriminant validity and test–retest reliability were established across all domains, although the test–retest reliability on scores for the Service Access and Political Engagement domains prior to first admission to hospital (T1) was lower than other domains. Inter-rater reliability was excellent for all domains at T1 and T2. CONCLUSIONS: The component ...

BACKGROUND: Rising annual incidence of involuntary hospitalisation have been reported in England and some other higher-income countries, but the reasons for this increase are unclear. We aimed to describe the extent of variations in involuntary annual hospitalisation rates between countries, to compare trends over time, and to explore whether variations in legislation, demographics, economics, and health-care provision might be associated with variations in involuntary hospitalisation rates. METHODS: We compared annual incidence of involuntary hospitalisation between 2008 and 2017 (where available) for 22 countries across Europe, Australia, and New Zealand. We also obtained data on national legislation, demographic and economic factors (gross domestic product [GDP] per capita, prevalence of inequality and poverty, and the percentage of populations who are foreign born, members of ethnic minorities, or living in urban settings), and service characteristics (health-care spending and provision of psychiatric beds and mental health staff). Annual incidence data were obtained from government sources or published peer-reviewed literature. FINDINGS: The median rate of involuntary hospitalisation was 106·4 (IQR 58·5 to 150·9) per 100 000 people, with Austria having the highest (282 per 100 000 individuals) and Italy the lowest (14·5 per 100 000 individuals) most recently available rates. We observed no relationship between annual involuntary hospitalisation rates and any characteristics of the legal framework. Higher national rates of involuntary hospitalisation were associated with a larger number of beds (β coefficient 0·65, 95% CI 0·10 to 1·20, p=0·021), higher GDP per capita purchasing power parity (β coefficient 1·84, 0·30 to 3·38, p=0·019), health-care spending per capita (β coefficient 15·92, 3·34 to 28·49, p=0·013), the proportion of foreign-born individuals in the population (β coefficient 7·32, 0·44 to 14·19, p=0·037), and lower absolute poverty (β coefficient −11·5, −22·6 to −0·3, p=0·044). There was no ...

AbstractBackgroundAdults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs.MethodInterviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent).ResultsThematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models.ConclusionsISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community.