2.4 CARE
OF MENTAL
HEALTH AND
LEARNING DISABILITY
PATIENTS
2.4a Could the Department update the
information given in Tables 2.4, on patients under the care of
a learning disability or mental illness consultant, discharges
by length of stay, ages and destination, and residential and other
places available? Could the Department identify the number of
individuals concerned, and hence the number of repeat discharges?
2.4b Could the Department provide a table
showing:
(i) number of people sectioned, by trust
and by type of section?
(ii) number of people sectioned in proportion
to HA population? If the data are not available, will the Department
consider obtaining it from the HES?
(iii) number of people sectioned in proportion
to number of admissions?
(iv) proportion of people who appeal
against being sectioned and the outcomes of the appeals?
2.4c Could the Department provide a table
showing, over the last four years, the numbers of people with
mental health problems and with learning disabilities who have
been in special hospitals, prisons and regional secure units?
INTRODUCTION
1. Tables 2.4.1, 2.4.3 and 2.4.5 present
information on in-patients under the care of a learning disabilities
specialist. Similar information for patients under the care of
a mental illness specialist is given in tables 2.4.2, 2.4.4 and
2.4.6.
2. Tables 2.4.7 and 2.4.8 presents information
on beds available in the NHS and private nursing facilities and
places in residential care for people with learning disabilities.
3. Tables 2.4.1 to 2.4.6 are derived from
the Hospital Episode Statistics (HES) system. The figures in tables
2.4.3 to 2.4.6 are estimates and provisional.
2.4 Care of Mental Health and Learning Disability
Patients
2.4a Could the Department update the
information given in Tables 2.4, on patients under the care of
a learning disability or mental illness consultant, discharges
by length of stay, ages and destination, and residential and other
places available? Could the Department identify the number of
individuals concerned, and hence the number of repeat discharges?
CARE OF
PATIENTS UNDER
LEARNING DISABILITY
AND MENTAL
ILLNESS SPECIALTIES
4. The estimated number of in-patients under
the care of the learning disability specialty, at the end of each
year, fell to 6,100 in 2000 from 27,700 in 1990 (Table 2.4.1).
This is mainly due to the fall in the number of very long stay
patients, from 20,300 to 2,700 over the period. This fall in the
number of very long stay patients resulted from the closure of
long stay units and resettlement of patients in the community.
5. This is matched with a decrease in the
number of in-patients under the care of mental illness specialists,
at the end of the year, to 29,900 in 2000 from 56,200 in 1990.
Again, this is due mainly to large falls in the number of long
stay patients (Table 2.4.2).
6. There has been a substantial increase
in the number of patients with learning disability discharged
from hospital after a short stay. Table 2.4.3 shows that 74 per
cent of patients had been in hospital for less than a week. This
compares with 63 per cent of those in 1990; this probably reflects
the increased provision of respite care.
7. Table 2.4.4 shows an increase in the
number of short stay episodes of mental illness in-patient care;
there were an estimated 122,800 discharges in 1999-2000 with a
stay of under one month, compared to 121,300 discharges in 1990.
8. Table 2.4.5 shows that most learning
disability patients under 65 discharged after a length of stay
of less than a year return to their usual place of residence (98
per cent in 1999-2000). This compares with an estimated 88 per
cent for mental illness patients in the same year (Table 2.4.6).
9. In the case of learning disability, patients
aged 65 or over, 80 per cent return to their usual place of residence
with a further 10 per cent transferred to other NHS trusts. This
compares to 69 per cent and 10 per cent respectively for mental
illness patients.
10. Of the learning disability patients
under 65 discharged after a stay of a year or more (an estimated
760 in 1999-2000), 20 per cent returned to their usual place of
residence, 45 per cent transferred to another NHS trust and 7
per cent to local authority homes or other non-NHS institutions.
In comparison, of discharged mental illness patients (an estimated
2,170 in 1999-2000), 44 per cent returned to their usual place
of residence, 28 per cent transferred to another NHS trust and
only 4 per cent to local authority homes or other non-NHS institutions.
11. Only an estimated 80 learning disability
patients aged 65 or over were discharged after a stay of a year
or more in 1999-2000, compared with 1,500 for mental illness patients;
the estimates of destination on discharge are based on small numbers
and are unlikely to be reliable.
12. Table 2.4.7 shows that, in NHS facilities,
the average daily number of beds on wards for patients with learning
disabilities has fallen to 10,600 in 1999-2000 from 26,400 in
1989-90. There has been a fall in the average daily number of
beds available for mentally ill patients in NHS facilities to
35,500 in 1999-2000 from 59,300 in 1989-90 (Table 2.4.8). The
number of long stay adult beds in learning disability wards has
fallen to 4,700 in 1999-2000 from 25,000 in 1989-90 with little
change in the number of short stay beds. Similarly the number
of long stay beds in mental illness wards has fallen to around
a quarter of the number in 1989-90 with only a slight drop in
the number of short stay beds.
13. In private nursing homes the number
of learning disabilities beds for adults has increased almost
three fold over the ten year period to 3,790 beds in 1999-2000.
In staffed residential care (excluding small homes), the number
of beds for adults has almost doubled in the ten-year period to
44,100 in 1999-2000. Residential places for children decreased
to 1,500 in March 2000 from 2,100 in March 1990.
14. The number of mental illness beds in
private nursing homes and hospitals increased to 28,700 in 1999-2000
from 7,700 in 1989-90. Most of the increase was in places for
elderly patients. In addition, a change in the method of data
collection in 1997-98 may also have had an effect on these figures.
NUMBER OF
REPEAT DISCHARGES
IN TABLES
2.4
15. The number of repeat discharges is not
available. It is not possible to generate data on the number of
times individual patients are discharged over a period of time
after completing their spell in hospital.
16. The Department does however compile,
as an indicator, the number of emergency psychiatric re-admissions.
Emergency psychiatric re-admissions are defined as patients aged
16-64 re-admitted as an emergency to the care of a psychiatric
specialist within 90 days of discharge. These include patients
under the care of a consultant with Mental illness, Forensic Psychiatry
and Psychotherapy specialties (codes: 710,712 and 713) excluding
those with a primary diagnosis of drug dependency, alcohol dependency
or eating disorder, (ICD 10 codes: F10 to F19, F50, Z502 and Z503).
The re-admission method must be those counted as an emergency.
It is important to note that the definition and coverage of this
indicator differs from that applied to psychiatric discharges
in Tables 2.4.3 and 2.4.4.
17. In 2000-01 the number of emergency re-admissions
in England were 14,100 compared to 110,300 discharges in the same
year (discharges are measured with the coverage described above
for psychiatric re-admissions). This represents a re-admission
rate of 13 per cent.
Table 2.4.1
PATIENTS UNDER THE CARE OF A LEARNING DISABILITIES
CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND : 1990, 1994
TO 2000 (2)

Footnotes:
1 Figures for 1997 are not available, trust
level data not submitted for this exercise.
2 Figures for 1994 to 2000 have been estimated
from the number of unfinished consultant episodes at 31 March.
They are estimates based on returns to the Department from Trusts.
These are not directly comparable with figures for earlier years,
as the data from Hospital Episode Statistics is incomplete
Table 2.4.2
PATIENTS UNDER THE CARE OF A MENTAL ILLNESS
CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND : 1990, 1994
TO 2000 (2)

Footnotes:
1 Figures for 1997 are not available. Required
data not collected from Trusts.
2 Figures for 1994 to 2000 have been estimated
from the number of unfinished consultant episodes at 31 March.
They are estimates based on returns to the Department from Trusts.
These are not directly comparable with figures for earlier years,
as the data from Hospital Episode Statistics is incomplete.
Table 2.4.3
ESTIMATED DISCHARGES OF LEARNING DISABILITIES
PATIENTS FROM NHS FACILITIES BY DURATION OF STAY 1989-90 AND 1993-94
TO 1999-2000 (2)

Source: HES.
Footnotes:
1 Figures include transfers to other NHS
providers. All durations include age unknown data.
2 Estimates for 1998-99 and 1999-2000 are
provisional.
3 Percentages have been calculated using
unrounded figures.
Table 2.4.4
ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS
FROM NHS FACILITIES BY DURATION OF STAY 1989-90 AND 1993-94 TO
1999-2000 (1)

Source: HES.
Footnotes :
1 Figures include transfers to other NHS
providers. All durations include age unknown data.
2 Estimates for 1998-99 and 1999-2000 are
provisional.
3 Percentages have been calculated using
unrounded figures.
Table 2.4.5
ESTIMATED DISCHARGES OF LEARNING DISABILITY
PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION
1993-94 AND 1999-2000

Source: HES.
Footnotes:
1 Estimates for 1999-2000 are provisional.
2 Age unknowns data are not included.
3 Percentages relate to intended discharge
of patients as recorded inpatients' notes and are based on unrounded
data.
4 Usual residence excludes the other categories
listed in this table. It includes private dwellings whether owner
occupied or rented and sheltered accommodation but not residential
or nursing care. It includes patients with no fixed abode.
5 Other NHS Trust hospitals or NHS run nursing
homes.
6 Independent residential or nursing care
homes and private hospitals.
7 Prison, high security psychiatric hospitals,
not known.
Table 2.4.6
ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS
FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1993-94
AND 1999-2000

Source: HES.
Footnotes:
1 Estimates for 1999-2000 are provisional.
2 Age unknowns data are not included.
3 Percentages relate to intended discharge
of patients as recorded inpatients' notes and are based on unrounded
data.
4 Usual residence excludes the other categories
listed in this table. It includes private dwellings whether owner
occupied or rented and sheltered accommodation but not residential
or nursing care. It includes patients with no fixed abode.
5 Other NHS Trust hospitals or NHS run nursing
homes.
6 Independent residential or nursing care
homes and private hospitals.
7 Prison, high security psychiatric hospitals,
not known.