Keown Patrick, Mercer Gavin, Scott Jan
East Community Mental Health Team, Molineux Street NHS Centre, Newcastle upon Tyne NE6 1SG.
BMJ. 2008 Oct 9;337:a1837. doi: 10.1136/bmj.a1837.
To analyse the number of voluntary and involuntary (detentions under the Mental Health Act 1983) admissions for mental disorders between 1996 and 2006 in England.
Retrospective analysis.
England.
Number of voluntary and involuntary admissions for mental disorders in England's health service, number of involuntary admissions to private beds, and number of NHS beds for patients with mental disorders or learning disabilities.
Admissions for mental disorders in the NHS in England peaked in 1998 and then started to fall. Reductions in admissions were confined to patients with depression, learning disabilities, or dementia. Admissions for schizophrenic and manic disorders did not change whereas those for drug and alcohol problems increased. The number of NHS psychiatric beds decreased by 29%. The total number of involuntary admissions per annum increased by 20%, with a threefold increase in the likelihood of admission to a private facility. Patients admitted involuntarily occupied 23% of NHS psychiatric beds in 1996 but 36% in 2006.
Psychiatric inpatient care changed considerably in the decade from 1996 to 2006, with more involuntary admissions to fewer NHS beds. The case mix has shifted further towards psychotic and substance misuse disorders, which has changed the milieu of inpatient wards. Increasing proportions of involuntary patients were admitted to private facilities.
分析1996年至2006年英格兰精神障碍患者自愿及非自愿（依据1983年《精神健康法》进行的拘留）住院治疗的人数。
回顾性分析。
英格兰。
英格兰医疗服务体系中精神障碍患者自愿及非自愿住院治疗的人数、私立床位的非自愿住院人数，以及为精神障碍或学习障碍患者提供的国民保健服务（NHS）床位数量。
英格兰国民保健服务体系中精神障碍患者的住院人数在1998年达到峰值，随后开始下降。住院人数的减少仅限于抑郁症、学习障碍或痴呆症患者。精神分裂症和躁狂症患者的住院人数没有变化，而药物和酒精问题患者的住院人数有所增加。国民保健服务体系的精神科床位数量减少了29%。每年非自愿住院患者的总数增加了20%，入住私立机构的可能性增加了两倍。1996年，非自愿住院患者占国民保健服务体系精神科床位的23%，但在2006年这一比例为36%。
从1996年到2006年的十年间，精神科住院治疗发生了很大变化，非自愿住院患者增多，而国民保健服务体系的床位减少。病例组合进一步向精神病和药物滥用障碍转移，这改变了住院病房的环境。越来越多的非自愿患者被收治到私立机构。
