Faculty of Health and Social Care, University of Chester, Chester, UK.
Department of Entomology, Gardner Hall, Derieux Place, North Carolina State University, Raleigh NC 27695, USA.
Gen Hosp Psychiatry. 2014 Jul-Aug;36(4):442-8. doi: 10.1016/j.genhosppsych.2014.02.006. Epub 2014 Feb 12.
The number of psychiatric hospital beds in England has declined since the 1950s. Since the early 2000s, mental health staff increasingly work in community treatment teams. We analysed recent trends in hospital and community treatment in England for eight mental health diagnoses.
We obtained data from the UK Government Health and Social Care Information Centre covering the period 1998 to 2012. We analysed hospital admissions and length of stay for each diagnosis each year using linear regression. We studied associations among admissions, community treatment and hospital bed availability each year using structural equation modeling.
The number of mental health beds fell 39%, from 37,000 in 1998 to 22,300 in 2012. Hospital admissions for five diagnoses declined significantly (depression, bipolar disorder, schizophrenia, dementia and obsessive compulsive disorder, P<.01 or P<.001). The strongest decline for depression involved 1000 fewer admissions each year. Admissions for three disorders increased significantly (posttraumatic stress disorder, eating disorders and alcohol-related disorders, P<.01 or P<.001). Alcohol-related admissions increased most strongly, by more than 1700 a year, and were significantly associated with increasing liver fibrosis and cirrhosis admissions (Pearson's r=0.89, P<.001) across the National Health Service (NHS) and the affordability of alcohol (Pearson's r=0.76, P<.01). The median length of stay declined significantly for four diagnoses (P<.001); the other four diagnoses did not change significantly. Depression had the steepest decline of almost 1 less day in hospital per admission per year. Almost 300 more patients were sectioned under the Mental Health Act each year. Community activity had relatively little effect on admissions, and its direct effect was not significantly different from zero. Years with more psychiatric beds had more admissions.
Mental health bed numbers have declined significantly in England. Annual admissions and lengths of stay declined for a range of severe mental disorders including schizophrenia, bipolar disorder and depression. The fall in available beds can account for much of the decline in admissions. National reports of crisis team activity are not associated with declines in hospital admissions. There may be significant needs, especially of depressive patients, not being met by secondary community services, such as 24-hour observation and care. This calls for policy review and further epidemiological study of morbidity, mortality and health needs associated with mental disorder in the community.
自 20 世纪 50 年代以来，英国精神病院的床位数量一直在减少。自 21 世纪初以来，精神卫生工作人员越来越多地在社区治疗小组中工作。我们分析了英格兰 8 种精神健康诊断的最近住院和社区治疗趋势。
我们从英国政府健康和社会保健信息中心获得了 1998 年至 2012 年的数据。我们使用线性回归分析了每年每种诊断的住院人数和住院时间。我们使用结构方程模型研究了每年入院、社区治疗和医院床位供应之间的关系。
精神卫生床位减少了 39%，从 1998 年的 37000 张减少到 2012 年的 22300 张。五种诊断的住院人数明显下降（抑郁症、双相情感障碍、精神分裂症、痴呆症和强迫症，P<.01 或 P<.001）。抑郁症的下降幅度最大，每年减少 1000 例入院。三种疾病的入院人数明显增加（创伤后应激障碍、饮食障碍和与酒精有关的障碍，P<.01 或 P<.001）。与酒精相关的入院人数增加最多，每年增加 1700 多人，与国民保健服务（NHS）中肝脏纤维化和肝硬化入院人数（皮尔逊 r=0.89，P<.001）和酒精负担能力（皮尔逊 r=0.76，P<.01）呈显著正相关。四种诊断的中位住院时间明显下降（P<.001）；其他四种诊断没有显著变化。抑郁症的住院时间每年减少近 1 天，降幅最大。根据《精神卫生法》，每年有近 300 名患者被强制入院。社区活动对入院人数的影响相对较小，其直接影响与零无显著差异。有更多精神科床位的年份入院人数更多。
英格兰的精神卫生床位数量显著下降。包括精神分裂症、双相情感障碍和抑郁症在内的一系列严重精神疾病的年入院人数和住院时间都有所下降。可用床位的减少可以解释大部分入院人数的下降。全国危机小组活动报告与住院人数下降无关。二级社区服务可能无法满足严重的需求，尤其是抑郁患者的需求，例如 24 小时观察和护理。这需要政策审查和对社区精神障碍相关发病率、死亡率和健康需求的进一步流行病学研究。
