3.5 Care of mental health and learning
disability patients
3.5.1 Could the Department update the information given
in Tables 3.5.1, 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? [3.5.1]
Care of Patients Under Learning Disability and Mental Illness
Specialities
1. The estimated number of in-patients under the care
of the learning disability specialty, at the end of each year,
fell to 6,000 in 2002-03 from 16,000 in 1992-93—see Table
3.5.1(a). This is mainly due to the fall in the number of
very long stay patients, from 9,400 to 1,800 over the period.
This is matched with a decrease in the number of in-patients under
the care of the mental illness specialty, at the end of the year,
to 29,100 in 2002-03 from 39,500 in 1992-93—see Table
3.5.1(b). This reflects a reduction in dependence on long-stay
hospital beds and growth in provision of alternative forms of
supported residential and home based services and community teams.
2. The caseload for Community Mental Health Teams increased
to 303,000 in 2002 from 252,000 in 2001, an increase of 50,000,
as published in the 2002 Atlas of the Mental Health Service Provision.
The caseload for 2003, as published on the Mental Health Service
Mapping website, increased to 310,000.
3. There has been a substantial increase in the proportion
of patients with learning disability discharged from hospital
after a short stay. Table 3.5.1(c) shows that 78% of patients
in 2002-03 had been in hospital for less than a week. This compares
with 68% of those in 1992-93; this probably reflects the increased
provision of respite care.
4. Table 3.5.1(d) shows a decrease in the number
of in-patient episodes of Mental Illness care lasting less than
one month. There were 112,200 discharges in 2002-03 after short
stay episodes (62% of all discharges) compared with 138,800 in
1992-93 (66% of all discharges).
5. Table 3.5.1(e) 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% in 2002-03).
This compares with an estimated 86% for mental illness patients
in the same year, see Table 3.5.1(f).
6. In the case of learning disability, patients aged
65 or over, 76% returned to their usual place of residence in
2002-03, with a further 18% transferred to other NHS providers.
This compares to 67% and 15% respectively for mental illness patients.
7. Of the learning disability patients under 65 discharged
after a stay of a year or more (an estimated 860 in 2002-03),
47% returned to their usual place of residence, 32% transferred
to another NHS provider and 17% to local authority homes or other
non-NHS institutions. For discharged mental illness patients (an
estimated 2,200 in 2002-03), 49% returned to their usual place
of residence, 20% transferred to another NHS provider and 16%
to local authority homes or other non-NHS institutions.
8. Only an estimated 110 learning disability patients
aged 65 or over were discharged after a stay of a year or more
in 2002-03, compared with 870 for mental illness patients; the
estimates of destination on discharge are based on small numbers
and are unlikely to be reliable.
9. Table 3.5.1(g) shows that, in NHS facilities,
the average daily number of beds on wards for patients with learning
disabilities has fallen to 8,100 in 2002-03 from 18,500 in 1992-93.
10. There has been a fall in the average daily number
of beds available for mentally ill patients in NHS facilities
to 34,400 in 2002-03 from 47,300 in 1992-93—see Table
3.5.1(h). The number of long stay adult beds in learning disability
wards has fallen to 3,000 in 2002-03 from 16,600 in 1992-93 with
little change in the number of short stay beds. Similarly, the
number of long stay adult beds in mental illness wards has fallen
to around 35% of the number in 1992-93 with only a slight drop
in the number of short stay beds.
11. In private nursing homes the number of learning disabilities
beds for adults rose by about a third to 3,700 beds in 2000-01
from 2,800 in 1992-93. In staffed residential care (excluding
small homes) the number of places for adults increased by 27%
over the same period, to 43,600 in 2000-01. Residential places
for children decreased to 1,500 in March 2001 from 2,100 in March
1993.
12. The number of mental illness beds in private nursing
homes and hospitals increased by around 70% to 28,800 in 2000-01
from 17,000 in 1992-93. Most of the increase was in beds for elderly
patients. Over the same period the number of places for adults
in staffed residential care (excluding small homes) increased
by almost 80%, to 37,800 in 2000-01.
13. Later information on places in care homes, private
hospitals and clinics is not yet available in comparable terms,
or to reliable statistical standards. Following the establishment
of the National Care Standards Commission (NCSC) on 1 April 2002
the routine statistical collections carried out by the Department
of Health were discontinued and it was planned that future information
would be provided from the NCSC database. However, the operational
and technical problems experienced with the NCSC database have
continued into the life of the new Commission for Social Care
Inspection (to which the NCSC functions covering care homes were
transferred in April 2004) and the Healthcare Commission (to which
the NCSC functions covering private hospitals and clinics were
transferred in April 2004).
14. Work is actively underway to create reliable data
outputs for the future, but for the moment, only limited data
of uncertain quality can be produced.
Number of Repeat Discharges in Tables 3.5.1
15. The number of repeat discharges is not available.
It is not yet possible to reliably 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 use, two indicators,
compiled by the Healthcare Commission, reflecting the number of
emergency psychiatric re-admissions. One, "psychiatric re-admissions
(adults)", for patients aged 17-64 re-admitted as an emergency
to the care of a psychiatric specialist within 28 days of discharge,
relates to Mental Health National Service Framework standard 4.
The other, "psychiatric re-admissions (older people)",
is for people aged over 65. The "psychiatric re-admissions
(adults)" indicator covers patients under a consultant whose
specialty is Mental Illness or Old Age Psychiatry and is based
on HES data. However, it excludes any patients with a primary
diagnosis of substance abuse or eating disorder, (ICD 10 codes:
F10 to F19, F50, Z50.2 and Z50.3). For these excluded conditions,
re-admission is often considered a necessary part of the care.
It should also be noted that any planned re-admissions are excluded
from the count of re-admissions.
17. It is very important to note that the definition
and coverage of this indicator differs from that applied to psychiatric
discharges in Tables 3.5.1(c) and 3.5.1(d).
18. The Healthcare Commission have calculated and published
re-admission rates for individual organisations for the calendar
year 2003. They do calculate an England rate but have concerns
over the robustness of this figure for 2003. These concerns are
due partly to each of two factors. Firstly, due to the timing
of the ratings publication the Department of Health provide them
with provisional data and not the final end of year dataset. Secondly,
when assessing the quality of individual organisation's data for
2003, the Commission deemed a relatively high percentage of trust's
HES data as being unreliable. Consequently, the 2003 England rate
is not provided here.
Table 3.5.1(a)
PATIENTS UNDER THE CARE OF A LEARNING DISABILITIES CONSULTANT
AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1993, 1997 TO 2003 (2)
|
| England | Estimated numbers and rates per 100,000 population
|
| Duration of stay | 1993
| 1997 (1) | 1998
| 1999 | 2000
| 2001 | 2002
| 2003 |
|
| Number of patients |
| All Durations | 16,000
| — | 8,400
| 7,100 | 6,050
| 6,500 | 5,350
| 6,000 |
| Under 1 year | 2,500
| — | 1,900
| 1,950 | 1,350
| 1,500 | 1,450
| 2,750 |
| 1 to 2 years | 1,700
| — | 800
| 650 | 700
| 600 | 550
| 450 |
| 2 to 3 years | 1,000
| — | 650
| 500 | 550
| 600 | 400
| 450 |
| 3 to 5 years | 1,400
| — | 700
| 900 | 750
| 750 | 600
| 450 |
| 5 years and over | 9,400
| — | 4,400
| 3,100 | 2,700
| 3,100 | 2,400
| 1,800 |
| | |
| | | |
| | |
| Rates per 100,000 population
|
| All Durations | 33
| — | 17
| 15 | 12
| 13 | 11
| 12 |
| Under 1 year | 5
| — | 4
| 4 | 3
| 3 | 3
| 6 |
| 1 to 2 years | 4
| — | 2
| 1 | 1
| 1 | 1
| 1 |
| 2 to 3 years | 2
| — | 1
| 1 | 1
| 1 | 1
| 1 |
| 3 to 5 years | 3
| — | 1
| 2 | 2
| 2 | 1
| 1 |
| 5 years and over | 20
| — | 9
| 6 | 6
| 6 | 5
| 4 |
|
Footnotes:
1. Figures for 1997 are not available, trust level data not
submitted for this exercise.
2. Figures for 1998 to 2003 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.
3. Population rates use the 2002 population estimate based
on the 2001 census.
Table 3.5.1(b)
PATIENTS UNDER THE CARE OF A MENTAL ILLNESS CONSULTANT
AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1993, 1997 TO 2003 (2)
|
| England | Estimated numbers and rates per 100,000 population
|
|
| Duration of stay | 1993
| 1997 (1) | 1998
| 1999 | 2000
| 2001 | 2002
| 2003 |
Number of patients
All Durations
| 39,500 | —
| 31,750 | 30,800
| 29,900 | 31,550
| 31,350 | 29,050
|
| Under 1 year | 22,200
| — | 23,500
| 22,900 | 21,200
| 22,750 | 23,200
| 21,600 |
| 1 to 2 years | 4,600
| — | 2,700
| 2,750 | 3,400
| 2,750 | 2,900
| 2,700 |
| 2 to 3 years | 2,800
| — | 1,450
| 1,500 | 1,600
| 1,850 | 1,300
| 1,900 |
| 3 to 5 years | 3,500
| — | 1,750
| 1,600 | 1,550
| 2,150 | 1,800
| 1,300 |
| 5 years and over | 6,400
| — | 2,350
| 2,050 | 2,150
| 2,000 | 2,150
| 1,500 |
Rates per 100,000 population
All Durations
| 82 | —
| 65 | 63
| 61 | 64
| 63 | 59
|
| Under 1 year | 46
| — | 48
| 47 | 43
| 46 | 47
| 44 |
| 1 to 2 years | 10
| — | 6
| 6 | 7
| 6 | 6
| 5 |
| 2 to 3 years | 6
| — | 3
| 3 | 3
| 4 | 3
| 4 |
| 3 to 5 years | 7
| — | 4
| 3 | 3
| 4 | 4
| 3 |
| 5 years and over | 13
| — | 5
| 4 | 4
| 4 | 4
| 3 |
|
Footnotes:
1. Figures for 1997 are not available. Required data not collected from Trusts.
2. Figures for 1998 to 2003 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.
3. Population rates use the 2002 population estimate based on the 2001 census.
|
Table 3.5.1(c)
ESTIMATED DISCHARGES OF LEARNING DISABLILITES PATIENTS
FROM NHS FACILITIES BY DURATION OF STAY 1992-93 AND 1996-97 TO
2002-03(1)
|
| England | Numbers and percentages
|
|
| Duration of stay | 1992-93
| 1996-97 | 1997-98
| 1998-99 | 1999-2000
| 2000-01 | 2001-02
| 2002-03(2) |
| All durations | 54,620
| 54,910 | 56,390
| 49,710 | 38,550
| 36,000 | 38,200
| 35,600 |
| Under 1week | 37,240
| 40,800 | 42,100
| 33,590 | 28,670
| 26,850 | 29,400
| 27,710 |
| 1 week | 11,230
| 9,820 | 10,570
| 9,150 | 7,530
| 6,680 | 6,530
| 5,800 |
| 1 month | 1,200
| 1,190 | 1,180
| 890 | 790
| 660 | 680
| 540 |
| 3 months | 1,050
| 940 | 440
| 740 | 620
| 630 | 610
| 560 |
| 1 year | 490
| 310 | 400
| 280 | 230
| 270 | 210
| 280 |
| 2 years | 530
| 430 | 390
| 360 | 230
| 370 | 250
| 280 |
| 5 years | 520
| 230 | 400
| 200 | 190
| 250 | 200
| 170 |
| 10 years + | 2,370
| 1,150 | 760
| 510 | 250
| 290 | 320
| 240 |
| Duration unknown | —
| 40 | 160
| 3,990 | 40
| 10 | —
| 20 |
| Percentages(3) | |
| | |
| | | |
| All durations | 100
| 100 | 100
| 100 | 100
| 100 | 100
| 100 |
| Under 1 week | 68
| 74 | 74
| 75 | 68
| 75 | 77
| 78 |
| 1 week | 21 |
19 | 18
| 19 | 18
| 19 | 17
| 16 |
| 1 month | 2 |
2 | 2
| 2 | 2
| 2 | 2
| 2 |
| 3 months | 2
| 1 | 2
| 1 | 1
| 2 | 2
| 2 |
| 1 year | 1 |
1 | 1
| 1 | 1
| 1 | 1
| 1 |
| 2 years | 1 |
1 | 1
| 1 | 1
| 1 | 1
| 1 |
| 5 years | 1 |
0 | 0
| 1 | 0
| 1 | 1
| 0 |
| 10 years + | 4
| 2 | 2
| 1 | 1
| 1 | 1
| 1 |
| Duration unknown | 0
| 0 | 0
| 0 | 8
| 0 | 0
| 0 |
|
Source: HES
Footnotes:
1. Figures include transfers to other NHS providers. All durations
include age unknown data.
2. Estimates for 2002-03 are provisional as no adjustments
have been made for the shortfalls in data.
3. Percentages have been calculated using unrounded figures.
Table 3.5.1(d)
ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS
FACILITIES BY DURATION OF STAY 1992-93 AND 1996-97 TO 2002-03(1)
|
| England | Numbers and percentages
|
|
| Duration of stay | 1992-93
| 1996-97 | 1997-98
| 1998-99 | 1999-2000
| 2000-01 | 2001-02
| 2002-03(2) |
| All durations | 211,170
| 216,870 | 218,900
| 209,580 | 200,900
| 190,460 | 184,090
| 182,150 |
| Under 1 week | 43,700
| 48,300 | 47,500
| 47,250 | 45,640
| 42,740 | 41,860
| 41,930 |
| 1 week— | 95,060
| 93,740 | 92,040
| 86,810 | 82,230
| 75,240 | 71,540
| 70,300 |
| 1 month— | 51,650
| 52,890 | 54,500
| 51,250 | 50,500
| 47,970 | 47,060
| 45,850 |
| 3 months— | 16,380
| 18,920 | 14,860
| 20,060 | 19,400
| 20,400 | 20,710
| 20,110 |
| 1 year— | 1,680
| 1,590 | 5,490
| 1,820 | 1,770
| 2,210 | 1,730
| 1,980 |
| 2 years— | 1,170
| 900 | 1,830
| 1,000 | 940
| 1,300 | 830
| 840 |
| 5 years— | 540
| 220 | 830
| 260 | 240
| 370 | 230
| 210 |
| 10 years + | 980
| 280 | 430
| 170 | 110
| 120 | 120
| 80 |
| Duration Unknown | 10
| 40 | 1,430
| 960 | 170
| 110 | 30
| 860 |
| Percentages(3) | |
| | |
| | | |
| All durations | 100
| 100 | 100
| 100 | 100
| 100 | 100
| 100 |
| Under 1 week— | 21
| 22 | 22
| 22 | 23
| 22 | 23
| 23 |
| 1 week— | 45
| 44 | 43
| 42 | 41
| 40 | 39
| 39 |
| 1 month— | 24
| 24 | 24
| 25 | 24
| 25 | 26
| 25 |
| 3 months— | 8
| 8 | 9
| 7 | 10
| 11 | 11
| 11 |
| 1 year— | 1
| 1 | 1
| 3 | 1
| 1 | 1
| 1 |
| 2 years— | 1
| 0 | 0
| 3 | 0
| 1 | 0
| 0 |
| 5 years— | 0
| 0 | 0
| 0 | 0
| 0 | 0
| 0 |
| 10 years+ | 0
| 0 | 0
| 0 | 0
| 0 | 0
| 0 |
| Duration Unknown | 0
| 1 | 0
| 1 | 0
| 0 | 0
| 0 |
|
Source: HES
Footnotes:
1. Figures include transfers to other NHS providers. All durations
include age unknown data.
2. Estimates for 2002-03 provisional as no adjustments have
been made for the shortfalls in data.
3. Percentages have been calculated using unrounded figures.
Table 3.5.1(e)
ESTIMATED DISCHARGES OF LEARNING DISABILITY PATIENTS FROM
NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1996-97
AND 2002-03
|
| England | number and percentages
|
| 1996-97
| 2002-03(1)
|
| Intended discharge destination | length of stay
less than
one year
| length of stay
of one year
or more
| length of stay
less than
one year
| length of stay
of one year
or more
|
|
| Aged under 65 |
| | | |
| NUMBER OF DISCHARGES(2) | 52,100
| 1,740 | 34,330
| 860 |
| Percentage(3) |
| | | |
| Usual Residence(4) | 98
| 28 | 98
| 47 |
| Temporary Residence | 0
| 1 | 0
| 2 |
| Other NHS provider(5) | 1
| 31 | 1
| 32 |
| LA residential | 0
| 5 | 0
| 5 |
| Non NHS institution(6) | 0
| 21 | 0
| 12 |
| Other and not known(7) | 0
| 15 | 0
| 3 |
| Aged 65 or over |
| | | |
| NUMBER OF DISCHARGES(2) | 650
| 380 | 280
| 110 |
| Percentage(3) |
| | | |
| Usual Residence(4) | 69
| 22 | 76
| 52 |
| Temporary Residence | 1
| 0 | 1
| 1 |
| Other NHS provider(5) | 20
| 35 | 18
| 29 |
| LA residential | 1
| 6 | 0
| 0 |
| Non NHS institution(6) | 8
| 22 | 4
| 12 |
| Other and not known(7) | 1
| 16 | 0
| 6 |
|
| Source: HES | |
| | |
Footnotes:
1. Estimates for 2002-03 are provisional as no adjustments
have been made for shortfalls in data.
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 3.5.1(f)
ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS
FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION 1996-97 AND
2002-03
|
| England | number and percentages
|
| 1996-97
| 2002-03(1)
|
| Intended discharge destination | length of stay
less than
one year
| length of stay
of one year
or more
| length of stay
less than
one year
| length of stay
of one year
or more
|
|
| Aged under 65 |
| | | |
| NUMBER OF DISCHARGES(2) | 141,590
| 1,980 | 126,910
| 2,230 |
| Percentage(3) |
| | | |
| Usual Residence(4) | 88
| 48 | 86
| 49 |
| Temporary Residence | 3
| 6 | 3
| 10 |
| Other NHS provider(5) | 6
| 28 | 6
| 20 |
| LA residential | 1
| 7 | 0
| 4 |
| Non NHS institution(6) | 1
| 9 | 1
| 12 |
| Other and not known(7) | 1
| 3 | 2
| 5 |
| Aged 65 or over |
| | | |
| NUMBER OF DISCHARGES(2) | 69,950
| 990 | 50,510
| 870 |
| Percentage(3) |
| | | |
| Usual Residence(4) | 76
| 30 | 67
| 22 |
| Temporary Residence | 3
| 5 | 2
| 4 |
| Other NHS provider(5) | 9
| 37 | 15
| 32 |
| LA residential | 3
| 5 | 2
| 4 |
| Non NHS institution(6) | 8
| 19 | 12
| 24 |
| Other and not known(7) | 1
| 4 | 2
| 14 |
|
Source: HES
Footnotes:
1. Estimates for 2002-03 are provisional as no adjustments
have been made for shortfalls in data.
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 3.5.1(g)
HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE
HOMES FOR PEOPLE WITH LEARNING DISABILITIES, ENGLAND: 1992-93,
1996-97 TO 2002-03
Numbers
|
| 1992-93 |
1996-97 | 1997-98
| 1998-99 | 1999-2000
| 2000-01 | 2001-02
| 2002-03 |
|
| Total available beds/places (excluding unstaffed)
| 57,920 | 65,760
| 67,540 | 68,420
| 69,440 | 68,650
| . | .
|
| Average daily number of available beds in NHS facilities
| 18,520 | 13,040
| 12,280 | 11,530
| 10,600 | 10,020
| 9,090 | 8,050
|
| For children | |
| | | |
| | |
| short stay | 200
| 290 | 280
| 270 | 290
| 280 | 210
| 270 |
| long stay | 210
| 110 | 100
| 100 | 90
| 100 | 70
| 140 |
| For other ages secure units | 300
| 420 | 440
| 420 | 400
| 430 | 410
| 510 |
| short stay | 1,250
| 1,350 | 1,440
| 1,420 | 1,340
| 1,320 | 1,370
| 1,120 |
| long stay | 16,560
| 7,440 | 5,940
| 5,280 | 4,720
| 4,190 | 3,640
| 3,000 |
| Residential Facilities(1) | .
| 3,430 | 4,080
| 4,040 | 3,760
| 3,700 | 3,390
| 3,010 |
| Beds in private nursing homes, hospitals and clinics(2)
| 2,850 | 3,360
| 3,580 | 3,850
| 3,840 | 3,770
| .. | ..
|
| Children | 50
| 60 | 70
| 100 | 50
| 60 | ..
| .. |
| Other ages | 2,800
| 3,300 | 3,510
| 3,750 | 3,790
| 3,710 | ..
| .. |
| Places in staffed residential homes for adults(2)(3)
| 34,450 | 40,500
| 41,580 | 42,610
| 44,130 | 43,580
| .. | ..
|
| Local authority | 10,890
| 8,190 | 8,200
| 7,380 | 7,100
| 6,630 | ..
| .. |
| Voluntary | 12,510
| 15,070 | 16,710
| 17,220 | 17,640
| 18,100 | ..
| .. |
| Private | 11,040
| 17,230 | 16,670
| 18,010 | 19,390
| 18,850 | ..
| .. |
| Places in staffed residential homes for children(2)(3)
| 2,110 | 1,480
| 1,720 | 1,590
| 1,430 | 1,540
| .. | ..
|
| Local authority | 1,610
| 950 | 1,070
| 1,040 | 800
| 890 | ..
| .. |
| Voluntary | 370
| 310 | 290
| 260 | 310
| 330 | ..
| .. |
| Private | 130
| 220 | 350
| 290 | 320
| 320 | ..
| .. |
| Places in small registered residential homes (<4 places)(2)
| . | 7,390
| 8,390 | 8,840
| 9,440 | 9,740
| .. | ..
|
| Voluntary | .
| .. | ..
| .. | ..
| .. | ..
| .. |
| Private | . |
.. | ..
| .. | ..
| .. | ..
| .. |
| Places in local authority unstaffed (group) homes(2)
| 3,000 | 2,990
| .. | ..
| .. | ..
| .. | ..
|
|
Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA(Form
A)
Footnotes:
1. NHS residential facilities were recorded for the first
time in 1996-97. Some of these beds may previously have been
recorded under other headings.
2. Data relate to 31 March.
3. Excludes nursing care places in dual registered homes.
. = not applicable, .. = not available.
Table 3.5.1(h)
HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE
HOMES FOR PEOPLE WITH MENTAL ILLNESS, ENGLAND: 1992-93, 1996-97
TO 2002-03
Numbers
|
| 1992-93 |
1996-97 | 1997-98
| 1998-99 | 1999-2000
| 2000-01 | 2001-02
| 2002-03 |
|
| Total available beds/places | 85,380
| 104,190 | 104,910
| 104,240 | 104,230
| 104,370 | .
| . |
| (excluding unstaffed)(1) |
| | | |
| | | |
| Average daily number of available beds in NHS facilities
| 47,310 | 38,780
| 37,880 | 37,060
| 35,470 | 35,490
| 33,980 | 34,390
|
| For children | |
| | | |
| | |
| short stay | 580
| 430 | 400
| 420 | 390
| 410 | 400
| 410 |
| long stay | 60
| 110 | 120
| 120 | 100
| 120 | 90
| 100 |
| For elderly | |
| | | |
| | |
| short stay | 5,770
| 7,370 | 7,380
| 7,290 | 7,350
| 7,620 | 7,550
| 7,480 |
| long stay | 13,660
| 8,230 | 7,410
| 6,990 | 6,040
| 5,540 | 5,250
| 5,080 |
| For other ages | |
| | | |
| | |
| secure units | 930
| 1,580 | 1,920
| 1,750 | 1,880
| 1,950 | 1,850
| 2,060 |
| short stay | 15,300
| 14,500 | 14,460
| 14,420 | 14,120
| 14,380 | 13,800
| 13,740 |
| long stay | 11,000
| 5,410 | 4,910
| 4,710 | 4,310
| 4,200 | 3,850
| 3,890 |
| Residential Facilities(2) | .
| 1,160 | 1,280
| 1,360 | 1,300
| 1,280 | 1,190
| 1,630 |
| Beds in private nursing ethomes, hospitals and clinics(3)(4)
| 16,950 | 28,510
| 28,280 | 28,940
| 28,710 | 28,780
| .. | ..
|
| Children | 10
| 60 | 100
| 50 | 10
| 70 | ..
| .. |
| Elderly | 12,400
| 21,450 | 19,130
| 20,770 | 21,830
| 21,490 | ..
| .. |
| Other ages | 4,540
| 6,990 | 9,050
| 8,120 | 6,870
| 7,210 | ..
| .. |
| Places in staffed residential homes for adults(1)(3)(5)
| 21,130 | 34,190
| 36,160 | 35,780
| 37,790 | 37,780
| .. | ..
|
| Local authority | 5,350
| 4,910 | 4,530
| 3,480 | 4,120
| 3,910 | ..
| .. |
| Voluntary | 4,940
| 7,270 | 7,070
| 6,280 | 6,770
| 6,720 | ..
| .. |
| Private | 10,840
| 22,010 | 24,560
| 26,030 | 26,900
| 27,150 | ..
| .. |
| Places in small registered residential homes (<4 places)(3)
| . | 2,710
| 2,590 | 2,460
| 2,260 | 2,320
| .. | ..
|
| Voluntary | .
| .. | ..
| .. | ..
| .. | ..
| .. |
| Private | . |
.. | ..
| .. | ..
| .. | ..
| .. |
| Places in local authority unstaffed (group) homes(3)
| 1,840 | 1,840
| .. | ..
| .. | ..
| .. | ..
|
|
Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA
(Form A)
Footnotes:
1. Discontinuity in data due to reclasification of some Elderly
homes as homes for Elderly Mentally Ill patients.
2. NHS residential facilities were recorded for the first
time in 1996-97. Some of these beds may previously have been recorded
under other headings.
3. Data relate to 31 March.
4. The method of data collection was changed in 1997-98 so
the figures for 1997-98 are not strictly comparable with those
for earlier years.
5. Excludes nursing care places in dual registered homes.
. = not applicable, .. = not available.
3.5.2 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? [3.5.2]
Number of People Sectioned by Trust and the type of section
1. Table 3.5.2(a) presents information on the
number of admissions to NHS facilities (trusts, care trusts and
primary care trusts) where the patient was detained under the
Mental Health Act 1983 at admission, and the number of occasions
a patient already in hospital as an informal patient was placed
under detention.
2. Table 3.5.2(b) shows similar information for
independent hospitals, as defined by the Care Standards Act 2000,
in each SHA area (these data were forwarded to the Department
directly from the independent hospitals). There were a total of
25,400 formal admissions to NHS facilities in 2002-03 with a further
1,300 formal admissions to independent hospitals. Another 20,200
changes from informal to formal detentions were recorded (19,700
in the NHS and 500 in independent hospitals). There may be double
counting of patients where a patient has been detained more than
once in the year.
Number of people sectioned in proportion to SHA population
3. It is not possible to produce reliable figures on
the numbers of people sectioned by SHA area of residence. The
data provided on the aggregate return is provider based and does
not collect geographic information on the area of residence. The
Hospital Episode Statistics (HES) system does have some information
on patients treated by area of residence, but the quality of data
is poor on admissions of formally detained patients.
4. It is possible to look at the variation in the rate
of psychiatric activity by health authority area of residence.
Table 3.5.2(c) shows 2002-03 rate of consultant episodes
varied from less than 2.62 to 6.17 per 1,000, with an average
of 4.55 per 1,000 population. This does not imply similar variations
in the rates for those sectioned.
Number of People Sectioned in Proportion to Admissions
5. In England, in 2002-03, there were 26,700 formal admissions
to hospital (including high security hospitals and private hospitals)
under the Act and a further 20,200 changes from informal status
to detention where patients were already in hospital. A patient
subject to more than one period of detention under the Act during
the year will be counted in these figures each time they are admitted
to hospital under detention or have a change from informal status
while in hospital. It is therefore not possible to determine the
number of people sectioned. Around 14.5% of all admissions (estimated
as 174,400) under psychiatric specialities in NHS hospitals in
2002-03 were formal admissions (25,400).
Table 3.5.2(a)
ADMISSIONS TO NHS FACILITIES UNDER THE MHA 1983 AND CHANGES
FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 2002-03(1)(2)
|
| | Numbers
| |
| Admitted to
hospital under
Section
| Subject to
Section after
admission(1)
| Total
detentions in
hospital
|
|
| England | 25,362 [24,540]
| 19,736 [21,073] | 45,098 [45,613]
|
| North East | 1,196 [1,048]
| 898 [965] | 2,094 [2,013]
|
| County Durham and Darlington Priority Services
| 232 | 180
| 412 |
| Gateshead Health | 28
| 17 | 45
|
| Newcastle Upon Tyne Hospitals | 2
| — | 2
|
| Newcastle, North Tyneside and Northumberland Mental Health
| 361 | 219
| 580 |
| Northgate and Prudhoe | 65
| 19 | 84
|
| Northumbria Health Care | 22
| 18 | 40
|
| South of Tyne and Wearside Mental Health |
212 | 242
| 454 |
| Tees and North East Yorkshire | 274
| 203 | 477
|
| North West | 3,168 [3,058]
| 3,101 [3,409] | 6,269 [6,467]
|
| 5 Boroughs Partnership | 276
| 325 | 601
|
| Calderstones | 24
| 13 | 37
|
| Cheshire and Wirral Partnership | 328
| 474 | 802
|
| Lancashire Care | 553
| 568 | 1,121
|
| Manchester Mental Health and Social Care |
396 | 301
| 697 |
| Mental Health Services of Salford | 416
| 382 | 798
|
| Mersey Care | 380
| 416 | 796
|
| Morecambe Bay PCT | 161
| 136 | 297
|
| North Cumbria Acute Hospitals | 1
| 3 | 4
|
| North Cumbria Mental Health and Learning Disabilities
| 115 | 73
| 188 |
| Pennine Acute Hospitals | 2
| 9 | 11
|
| Pennine Care | 391
| 290 | 681
|
| South Manchester University Hospital | 3
| — | 3
|
| Southport and Ormskirk Hospital | 1
| 1 | 2
|
| Stockport | 121
| 110 | 231
|
| Yorkshire and The Humber | 2,108 [1,997]
| 1,871 [1,977] | 3,979 [3,974]
|
| Barnsley PCT | 65
| 73 | 138
|
| Bradford District Care | 224
| 213 | 437
|
| Community Health Sheffield | 258
| 149 | 407
|
| Craven, Harrogate and Rural District PCT |
46 | 71
| 117 |
| Doncaster and South Humber Healthcare | 233
| 336 | 569
|
| Hambleton and Richmondshire PCT | 46
| 22 | 68
|
| Harrogate Health Care | 2
| 3 | 5
|
| Hull and East Riding Community Health |
185 | 191
| 376 |
| Leeds Mental Health Teaching | 517
| 305 | 822
|
| Leeds Teaching Hospitals | —
| 59 | 59
|
| Selby and York PCT | 87
| 95 | 182
|
| South West Yorkshire Mental Health | 443
| 343 | 786
|
| York Hospitals | 2
| 11 | 13
|
| East Midlands | 1,647 [1,648]
| 1,573 [1,472] | 3,220 [3,120]
|
| Chesterfield PCT | 33
| 14 | 47
|
| Derbyshire Mental Health Services | 294
| 323 | 617
|
| High Peak and Dales PCT | 5
| 1 | 6
|
| Leicestershire Partnership | 373
| 354 | 727
|
| Lincolnshire Partnership | 166
| 205 | 371
|
| North Eastern Derbyshire PCT | 6
| 1 | 7
|
| Northampton General Hospital | 1
| 4 | 5
|
| Northamptonshire Healthcare | 271
| 149 | 420
|
| Nottinghamshire Healthcare | 498
| 522 | 1,020
|
| West Midlands | 2,660 [2,573]
| 1,797 [1,819] | 4,457 [4,392]
|
| Birmingham Children's Hospital | 5
| — | 5
|
| Birmingham Heartlands and Solihull | —
| 5 | 5
|
| Black Country Mental Health | 127
| 82 | 209
|
| Coventry PCT | 210
| 165 | 375
|
| Dudley Beacon and Castle PCT | 101
| 84 | 185
|
| Dudley South PCT | 3
| 1 | 4
|
| Herefordshire PCT | 76
| 50 | 126
|
| North Staffordshire Combined Healthcare |
203 | 177
| 380 |
| North Warwickshire PCT | 77
| 66 | 143
|
| Northern Birmingham Mental Health | 388
| 149 | 537
|
| Royal Shrewsbury Hospitals | 1
| 10 | 11
|
| Shropshire County PCT | 326
| 179 | 505
|
| South Birmingham Mental Health | 370
| 329 | 699
|
| South Birmingham PCT | 6
| 2 | 8
|
| South Staffordshire Healthcare | 217
| 159 | 376
|
| South Warwickshire PCT | 70
| 67 | 137
|
| Walsall Hospitals | 6
| 13 | 19
|
| Walsall PCT | 141
| 53 | 194
|
| Wolverhampton Health Care | 119
| 96 | 215
|
| Worcestershire Mental Health Partnership |
214 | 110
| 324 |
| East of England | 2,184 [2,141]
| 1,622 [1,721] | 3,806 [3,862]
|
| Bedfordshire and Luton Community | 298
| 105 | 403
|
| Cambridge and Peterborough Mental Health Partnership
| 306 | 230
| 536 |
| Colchester PCT | 3
| — | 3
|
| Hertfordshire Partnership | 411
| 221 | 632
|
| James Paget Healthcare | 1
| 1 | 2
|
| Local Health Partnerships | 240
| 188 | 428
|
| New Possibilities | 2
| — | 2
|
| Norfolk and Norwich University Hospital |
— | 20
| 20 |
| Norfolk Mental Health Care | 329
| 271 | 600
|
| North Essex Mental Health Partnership |
332 | 372
| 704 |
| Norwich PCT | 10
| — | 10
|
| South Essex Partnership | 216
| 138 | 354
|
| West Norfolk PCT | 36
| 76 | 112
|
| London | 6,305 [6,474]
| 4,313 [4,840] | 10,618 [11,314]
|
| Barnet, Enfield and Haringey Mental Health |
697 | 415
| 1,112 |
| Barts and The London | 2
| 12 | 14
|
| Brent PCT | 3
| 1 | 4
|
| Camden and Islington Mental Health | 916
| 98 | 1,014
|
| Central and North West London Mental Health
| 920 | 492
| 1,412 |
| Chingford, Wanstead and Woodford PCT | 4
| — | 4
|
| East London and The City Mental Health |
809 | 487
| 1,296 |
| King's College Hospital | 16
| 5 | 21
|
| Kingston Hospital | —
| 13 | 13
|
| North East London Mental Health | 384
| 307 | 691
|
| Oxleas | 384
| 305 | 689
|
| South London and Maudsley | 1,001
| 854 | 1,855
|
| South West London and St George's Mental Health
| 528 | 771
| 1,299 |
| The Hillingdon Hospital | 98
| 94 | 192
|
| University College London Hospital | 16
| 5 | 21
|
| West London Mental Health | 527
| 454 | 981
|
| South East | 3,800 [3,354]
| 2,795 [2,848] | 6,595 [6,202]
|
| Berkshire Healthcare | 484
| 180 | 664
|
| Buckinghamshire Mental Health | 196
| 95 | 291
|
| East Hampshire PCT | 51
| 31 | 82
|
| East Kent and Social Care Partnership | 239
| 271 | 510
|
| East Sussex County Healthcare | 201
| 152 | 353
|
| Isle of Wight Healthcare | 78
| 57 | 135
|
| Milton Keynes PCT | 55
| 68 | 123
|
| North West Surrey Mental Health Partnership
| 98 | 138
| 236 |
| Oxford Learning Disability | 10
| — | 10
|
| Oxford Radcliffe Hospital | 3
| 4 | 7
|
| Oxfordshire Mental Healthcare | 350
| 166 | 516
|
| Portsmouth City PCT | 357
| 212 | 569
|
| South Downs Health | 179
| 200 | 379
|
| Southampton University Hospitals | 3
| 22 | 25
|
| Stoke Mandeville Hospital | —
| 4 | 4
|
| Surrey Hampshire Borders | 144
| 214 | 358
|
| Surrey Oaklands | 135
| 149 | 284
|
| West Hampshire | 413
| 231 | 644
|
| West Kent and Social Care Trust | 404
| 273 | 677
|
| West Sussex Health and Social Care | 400
| 328 | 728
|
| South West | 2,294 [2,222]
| 1,766 [2,021] | 4,060 [4,243]
|
| Avon and Wiltshire Mental Health Partnership
| 650 | 540
| 1,190 |
| Bath and North East Somerset PCT | 5
| 7 | 12
|
| Cornwall Partnership | 231
| 193 | 424
|
| Devon Partnership | 415
| 235 | 650
|
| Dorset Health Care | 224
| 174 | 398
|
| Gloucestershire Partnership | 207
| 171 | 378
|
| North Bristol | 1
| 12 | 13
|
| North Dorset PCT | 82
| 74 | 156
|
| Plymouth Hospitals | 3
| 22 | 25
|
| Plymouth PCT | 219
| 191 | 410
|
| Royal Cornwall Hospitals | 7
| 9 | 16
|
| Somerset Partnership NHS and Social Care |
249 | 135
| 384 |
| Swindon and Marlborough | 1
| 3 | 4
|
| High Security Hospitals | -[25]
| -[1] | -[26]
|
|
Source: KP90
Footnotes:
1. Includes all changes from informal status to detention
under the Act, and detentions where the patient was initially
brought to hospital under Section 136 (Place of Safety Order).
2. The figures in brackets are the totals for 2001-02.
3. The high security psychiatric hospitals are now the responsibility
of NHS Trusts.
Table 3.5.2(b)
ADMISSIONS TO INDEPENDENT HOSPITALS UNDER THE MHA 1983
AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL,
ENGLAND: 2002-03(1)(2)
|
| | Numbers
| |
| Admitted to
hospital under
Section
| Subject to
Section after
admission(2)
| Total
detentions in
hospital
|
|
Independent Hospitals by GOR and SHA area
England
| 1,303 [1,669] |
503 [524] | 1,806 [2,193]
|
| North East | 56 [74]
| 15 [29] | 71 [103]
|
| County Durham and Tees Valley | 47
| 15 | 62
|
| Northumberland, Tyne and Wear | 9
| — | 9
|
| North West | 190 [147]
| 44 [34] | 234 [181]
|
| Cheshire and Merseyside | 55
| 5 | 60
|
| Cumbria and Lancashire | 23
| — | 23
|
| Greater Manchester | 112
| 39 | 151
|
| Yorkshire and The Humber | 115 [44]
| 25 [6] | 140 [50]
|
| North and East Yorkshire and North Lincolnshire
| 73 | 20
| 93 |
| South Yorkshire | 6
| — | 6
|
| West Yorkshire | 36
| 5 | 41
|
| East Midlands | 76 [27]
| 32 [10] | 108 [37]
|
| Leicestershire, Northamptonshire and Rutland
| 56 | 31
| 87 |
| Trent | 20
| 1 | 21
|
| West Midlands | 33 [14]
| 9 [12] | 42 [26]
|
| Birmingham and The Black Country | 13
| 7 | 20
|
| Shropshire and Staffordshire | 19
| 1 | 20
|
| West Midlands South | 1
| 1 | 2
|
| East of England | 89 [147]
| 45 [18] | 134 [165]
|
| Bedfordshire and Hertfordshire | 9
| 1 | 10
|
| Essex | 23
| 42 | 65
|
| Norfolk, Suffolk and Cambridgeshire | 57
| 2 | 59
|
| London | 450 [742]
| 129 [177] | 579 [919]
|
| North Central London | 49
| 32 | 81
|
| North East London | 182
| 42 | 224
|
| North West London | 109
| 29 | 138
|
| South East London | 90
| 25 | 115
|
| South West London | 20
| 1 | 21
|
| South East | 265 [449]
| 184 [227] | 449 [676]
|
| Hampshire and Isle of Wight | 27
| 20 | 47
|
| Kent and Medway | 10
| 11 | 21
|
| Surrey and Sussex | 161
| 147 | 308
|
| Thames Valley | 67
| 6 | 73
|
| South West | 29 [25]
| 20 [11] | 49 [36]
|
| Avon, Gloucestershire and Wiltshire | 20
| 20 | 40
|
| Dorset and Somerset | 1
| — | 1
|
| South West Peninsula | 8
| — | 8
|
|
Source: KP90
Footnotes:
1. Includes all changes from informal status to detention
under the Act, and detentions where the patient was initially
brought to hospital under Section 136 (Place of Safety Order).
2. The figures in brackets are the totals for 2001-02.
Table 3.5.2(c)
ALL CONSULTANT EPISODES(1) OF PATIENTS WITH MENTAL ILLNESS
BY STRATEGIC HEALTH AUTHORITY(1) OF RESIDENCE, 2002-03
|
| Health Authority Code | Health Authority Names(2)
| Episodes(3) | Rate
per 1,000
population(4)
|
|
| England | 225,715
| 4.55 |
| Q20 | Avon, Gloucestershire and Wiltshire
| 9,898 | 4.56
|
| Q02 | Bedfordshire and Hertfordshire
| 5,677 | 3.53
|
| Q27 | Birmingham and the Black Country
| 12,397 | 5.46
|
| Q15 | Cheshire and Merseyside
| 10,014 | 4.27
|
| Q10 | County Durham and Tees Valley
| 2,969 | 2.62
|
| Q28 | Coventry, Warwickshire, Herefordshire and Worcestershire
| 6,556 | 4.26
|
| Q13 | Cumbria and Lancashire
| 9,349 | 4.89
|
| Q22 | Dorset and Somerset |
6,287 | 5.24
|
| Q03 | Essex | 8,276
| 5.10 |
| Q14 | Greater Manchester |
11,083 | 4.41
|
| Q17 | Hampshire and Isle of Wight
| 9,735 | 5.44
|
| Q18 | Kent and Medway | 6,240
| 3.93 |
| Q25 | Leicestershire, Northamptonshire and Rutland
| 7,532 | 4.79
|
| Q01 | Norfolk, Suffolk and Cambridgeshire
| 11,108 | 5.07
|
| Q11 | North and East Yorkshire and North Lincolnshire
| 5,355 | 3.29
|
| Q05 | North Central London |
5,329 | 4.38
|
| Q06 | North East London |
7,353 | 4.78
|
| Q04 | North West London |
7,400 | 4.15
|
| Q09 | Northumberland, Tyne and Wear
| 6,905 | 5.00
|
| Q26 | Shropshire and Staffordshire
| 6,168 | 4.13
|
| Q07 | South East London |
7,451 | 4.92
|
| Q08 | South West London |
8,038 | 6.17
|
| Q21 | South West Peninsula |
8,068 | 5.07
|
| Q23 | South Yorkshire | 6,721
| 5.30 |
| Q19 | Surrey and Sussex |
10,574 | 4.13
|
| Q16 | Thames Valley | 7,613
| 3.63 |
| Q24 | Trent | 10,818
| 4.09 |
| Q12 | West Yorkshire | 10,801
| 5.17 |
|
Footnotes:
1. Hospital in-patients are assigned to a Consultant who is
responsible for their treatment, and their period of care under
a Consultant is termed a "Consultant Episode"
2. Strategic Health Authority of residence is the Strategic
Health Authority in which the patient lived in before admission.
This however may not be the same area where the treatment took
place. The Strategic Health Authority codes were introduced in
2002-03, previously Health Authority codes were used.
3. The figures are provisional as no adjustments have been
made for the shortfalls in data.
4. The population rates use the 2002 population estimate based
on the 2001 census, and have been rounded to the nearest 2 decimal
places.
Appeals
6. The Mental Health Review Tribunal is an independent
judicial body which hears applications and references by and on
behalf of patient's detained under the Mental Health Act 1983
as amended by the Mental Health (Patients in the Community) Act
1995. This includes patients admitted for assessment and/or treatment,
hospital orders, guardianship, after-care under supervision and
restricted patients which have come through the courts or transferred
to hospital from prison. In some cases the nearest relative can
also apply for the patient's detention to be reviewed. Most hearings
are a result of applications by the patient or the patient's legal
representative.
7. The act places a duty on Hospital Managers to refer
a case to the tribunal at the end of specified periods where a
patient has not had a hearing during that time. The Home Secretary
in restricted cases is also obliged to refer cases to the Tribunal
periodically and has a discretion to refer a patient's case at
any time.
8. In the calendar year 2003 there were 20,408 applications
and references for appeals. During the same period 7,323 cases
were aborted mostly because the patient was discharged by the
hospital or the application was withdrawn before the hearing.
There were 10,657 decided cases resulting in 1,847 discharges
(absolute, conditional, deferred or delayed).
3.5.3 Could the Department please update the information
provided in response to last year's questionnaire 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? [3.5.3]
HIGH SECURITY
HOSPITALS, MEDIUM
SECURE UNITS
AND PRISONS
1. Table 3.5.3 shows the total number of patients
in the high security hospitals at 31 December in each of the last
four years and the number of patients who were classified as having
a learning disability (coming within the Mental Health Act 1983
categories of mental impairment or severe mental impairment).
2. Overall patient numbers show an ongoing downward trend
and will probably continue to do so for the immediate future as
the NHS Plan commitment to move inappropriately placed patients
out of the high security hospitals is progressed. The starting
point for achieving this "Accelerated Discharge Programme"
(ADP), was the agreement with each NHS Executive Region as to
its expected contribution to the NHS Plan target of moving up
to 400 inappropriately placed patients out of the high security
hospitals by the end of 2004. It is anticipated that the ADP will
be successfully completed.
3. A high degree of priority within the ADP has been
given to the movement of women patients, many of whom did not
require the levels of physical security provided by the high security
hospitals. The reduction in the number of women patients means
that it was not viable to maintain a high security women's service
on more than one of the three hospital sites and a decision was
therefore taken to work towards a situation in which the only
high security women's service will be provided by Rampton Hospital.
4. By the end of November 2003, the women's service at
Ashworth Hospital had closed and all the women patients had either
moved to lower levels of security or, if still needing to be in
a high security environment, to Rampton Hospital. This contributed
to a significant reduction in the Ashworth Hospital patient population,
as reflected in Table 3.5.3. The women's service at Broadmoor
Hospital will also close in due course.
5. The full impact on high security hospital admissions
once mental health prison in-reach teams are fully up and running
remains uncertain. Whilst these teams should prevent some admissions
by improving the standard of community-type care available in
prison, they are also likely to improve the identification of
prisoners who require transfer to hospital for treatment of mental
health problems. Some of these individuals will require a high
security setting, although the effect on hospital facilities providing
medium and other levels of security is likely to be more significant.
6. Broadmoor and Rampton Hospitals are involved in pilot
projects for the assessment and treatment of people with dangerous
and severe personality disorder (DSPD). As at 31 December 2003,
Broadmoor Hospital was accommodating 9 DSPD patients (included
in the figure of 314 in Table 3.5.3) while Rampton Hospital had
yet to commence DSPD admissions. When both pilots are fully up
and running Broadmoor and Rampton Hospitals will each provide
70 beds for DSPD patients. The impact on high security hospital
patient numbers in the longer term arising from the development
of the policy for dealing with this client group will become clearer
as the pilot projects are evaluated.
7. Each of the high security hospitals is the responsibility
of an NHS Trust—Ashworth: Mersey Care NHS Trust, Broadmoor:
West London Mental Health NHS Trust, Rampton: Nottinghamshire
Healthcare NHS Trust.
Table 3.5.3
TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH SECURE HOSPITALS
|
| As at | Ashworth
| Broadmoor | Rampton
| Total |
|
| 31.12.2000 | 410
| 410 | 429
| 1,249 |
| 31.12.2001 | 405
| 382 | 392
| 1,179 |
| 31.12.2002 | 367
| 331 | 375
| 1,073 |
| 31.12.2003 | 289
| 314 | 372
| 975 |
|
TOTAL NUMBER OF PATIENTS WITH LEARNING DISABILITIES
IN HIGH SECURE HOSPITALS
|
| As at | Ashworth
| Broadmoor | Rampton
| Total |
|
| 31.12.2000 | 3
| 0 | 87
| 90 |
| 31.12.2001 | 3
| 0 | 87
| 90 |
| 31.12.2002 | 4
| 1 | 75
| 80 |
| 31.12.2003 | 2
| 0 | 63
| 65 |
|
Source: High Security Hospitals
8. The table indicates a continuing downward trend in
the total number of high security hospital patients and in the
number of patients with a classification of mental impairment/severe
mental impairment at 31 December 2003. All figures exclude patients
on trial leave of absence.
NUMBER OF
PEOPLE WITH
MENTAL HEALTH
PROBLEMS IN
MEDIUM SECURE
UNITS
9. The position remains, as in previous years, that we
are unable to supply data over the last four years for the number
of people with mental health problems and with learning disabilities
who have been in medium secure units. We know however, that there
has historically been pressure on medium secure and other secure
beds. Therefore, steps have been, and are being, taken to increase
the number of secure psychiatric beds.
10. Paragraph 14.27 of the NHS Plan referred to the extra
investment committed to create almost 500 extra secure beds by
April 2001. This target was achieved.
11. The difficulties in moving inappropriately placed
patients out of the high security hospitals, which have led to
delays in the admission of people who do need high security care
and treatment, including prisoners requiring transfer, is being
addressed through the ADP mentioned above. Linked to the movement
of patients out of high security hospitals is the paragraph 14.35
NHS Plan commitment to develop 200 long-term secure beds. The
anticipated successful achievement of this commitment will have
the effect of both reducing the pressure on high security beds
and improving access to beds at lower levels of security.
12. Paragraph 14.39 of the NHS Plan contained a commitment
to provide 140 hospital beds for people with severe personality
disorder who present a high risk to the public. Linked to this
is the development of medium secure beds, hostel places and community
teams for this group.
13. The development and modernisation of mental health
services, which is one of the Government's core national priorities,
has placed a focus on the local development of services to meet
the needs of the local population. In line with this policy, Regional
Specialised Commissioning Groups (RSCGs) took over responsibility
for the commissioning of high and medium secure psychiatric services
with effect from 1 April 2000. Each RSCG obtained the funding
for these services from the Health Authorities within its Region.
The RSCGs provided a more focused mechanism for identifying the
needs of their population and developing integrated local services.
As part of this process, they assessed to what extent additional
medium secure beds were required, and planned accordingly. This
included determining what role the independent sector should play
in the provision of such services.
14. In the spirit of Shifting the Balance of Power, high
and medium secure psychiatric services are now commissioned by
Primary Care Trusts (PCTs) but in a collaborative manner around
"Cluster Group" arrangements that have evolved from
the former RSCGs. The Cluster Groups are now charged with taking
forward the development of appropriate secure psychiatric services.
15. The three Trusts with responsibility for the high
security hospitals are performance managed by the relevant Strategic
Health Authorities. A National Oversight Group ensures that the
Secretary of State's specific duties under Section 4 of the National
Health Service Act 1977 to provide high security psychiatric care
are properly discharged.
PREVALENCE OF
MENTAL HEALTH
PROBLEMS IN
THE PRISON
POPULATION
16. It is not possible to state with any precision how
many prisoners have mental health problems at any one time. That
is not a question of the application of objective criteria but
is essentially a matter for the clinical judgement of the psychiatrists
responsible for each person's care and treatment. However, a survey
of mental ill health in the prison population undertaken in 1997
by the Office for National Statistics estimated that around 90%
of prisoners had at least one of the five disorders (personality
disorder, psychosis, neurosis, alcohol misuse, and drug dependence)
considered in the survey. Co-morbidity levels are also high. (Psychiatric
morbidity among prisoners in England and Wales ONS 1998).
17. The NHS Plan included firm commitments that, by 2004,
300 additional staff would be involved in providing mental health
services to prisoners and 5,000 prisoners at any one time would
be receiving more comprehensive mental health services in prison.
All prisoners with severe mental illness would be in receipt of
treatment, and no prisoner with serious mental illness would leave
prison without a care plan and a care co-ordinator. The NHS Plan
interim target of 150 in-reach staff in post by the end of 2002-03
has been achieved. The latest available returns, from November
2003, confirmed that the commitment to have over 300 additional
staff in post by April 2004 was on target to be met.
18. In December 2001, the then Prison Health Policy Unit
and Task Force published "Changing the Outlook, a Strategy
for Developing and Modernising Mental Health Services in Prisons".
This set out the vision of where prison mental health services
should be by 2006 and identified the steps that would have to
be taken if it were to be realised. Every prison is expected to
look critically, with its local NHS partner (Primary Care Trust)
at its existing provision to establish whether it meets the needs
identified in the establishment's joint health needs assessment
and conforms to the principles and standards set out in both the
Department of Health's National Service Framework for Mental Health
and "Changing the Outlook".
19. The basic principle underpinning the Strategy is
that mental health services for prisoners should, as far as possible,
be provided in the same way as they would be in the wider community.
Prisoners who, were they not in prison, would be treated in their
own homes under the care of Community Mental Health Teams (CMHTs),
should be treated on the wings, their prison "home".
Those needing more specialist care should be able to receive it
in the prison health care centre, and there should be quick and
effective mechanisms to transfer prisoners who need in-patient
treatment for mental disorder to hospital.
20. Prisoners who are already receiving treatment for
mental disorder in the community under, for example, the Care
Programme Approach should continue to have access to that level
of service while they are in prison and, if appropriate, on release.
More effective screening and assessment tools are being developed
to identify people with a mental illness on first reception into
custody, or who become ill whilst in prison.
21. Reflecting the wider community principle, at the
end of 2003 responsibility for delivering the vision of prison
mental health services laid down in "Changing the Outlook"
passed from Prison Health, to the National Institute for Mental
Health in England (NIMHE). The underlying ethos is that just as
NIMHE is supporting the improvement of mental health services
across the NHS, so should it do so with mental health services
for prisoners.
22. Prison mental health collaborative networks have
been established in each of the NIMHE regional development centres,
this has led to prisons working with their local NHS partners
to develop a range of community style services, to be delivered
within prisons by multi-disciplinary mental health in-reach teams.
The prison mental health in-reach project is thus the mechanism
by which the NHS Plan commitments will be fulfilled. Centrally
funded by NHS money, 18 prisons in England, plus the four Welsh
prisons, joined the project during 2001-02 and a further 26 prisons
came on stream during 2002-03. The project was extended to another
46 establishments during 2003-04, by which time it will be in
operation in the 90 or so establishments with the greatest mental
health need. Targeting funding in this way will help to ensure
that the project picks up the 5,000 or so prisoners with severe
and enduring mental illness so as to meet the NHS Plan commitment.
Between March 2004 and March 2006 NHS mental health in-reach investment
is expected to double so that it reaches £20 million by 2005-06.
23. The number of prisoners transferred to hospital under
sections 47 (sentenced prisoners) and 48 (unsentenced prisoners)
of the Mental Health Act 1983 rose by 76% between 1991 and 1994
but thereafter remained relatively stable at an average of 745
each year up to 1999. In 2002, the last year for which statistics
have been published, 639 prisoners were transferred under sections
47 and section 48. [Home Office Statistical Bulletin 14/03 Statistics
of Mentally Disordered Offenders 2002].
24. Tighter regular monitoring has been introduced to
identify prisoners who have been waiting unacceptably long periods
for transfer to psychiatric hospitals. All establishments must
provide regular returns to Prison Health showing how many prisoners
are awaiting either assessment or transfer, and of the latter,
how many have been waiting for more than three months following
acceptance. A protocol has been issued which sets out the required
actions of both the Prison Service and the NHS when a prisoner
reaches that three -month deadline.
