Variation in compulsory psychiatric inpatient admission in England: a cross-classified, multilevel analysis

Background The increasing rate of compulsory admission to psychiatric in-patient beds in England is concerning. Studying variation between places and services could be key to identifying targets for interventions to reverse this. We modelled spatial variation in compulsory admissions in England using national patient-level data, and quantified the extent to which patient, local area and service setting characteristics accounted for this variation.

Methods Cross-sectional, multilevel analysis of the 2010/11 Mental Health Minimum Data Set (MHMDS). Data were available for 1,238,188 patients, covering 64 NHS Provider Trusts (93%) and 31,865 Census Lower Super Output Areas (LSOAs) (98%). Primary outcome was compulsory admission to a mental illness bed, compared with people admitted voluntarily or receiving only community-based care.

Outcomes 7∙5% and 5∙6% of the variance in compulsory admission occurred at LSOA- and Provider Trustlevels, respectively, after adjusting for patient characteristics. Black patients were almost three times more likely to be admitted compulsorily than White patients (OR 2∙94, 95% CI 2∙90-2∙98). Compulsory admission was greater in more deprived areas (OR 1∙22, 95% CI 1∙18- 1∙27) and in areas with more non-white residents (OR 1∙51, 95% CI 1∙43-1∙59), after adjusting for confounders.

Interpretation Compulsory psychiatric in-patient admission varies significantly between local areas and services, independent of patient, area and service characteristics. Compulsory admission rates appear to reflect local factors, especially socio-economic and ethnic population composition. Understanding how these condition access to and use of mental health care is likely to be important for developing interventions to reduce compulsion.