The virtual institution: cross-sectional length of stay in general adult and forensic psychiatry beds

International Journal of Mental Health Systems

Harry G Kennedy⁴  Clare O’Toole¹  Warren Dunn²  Anand Sharma³ 

[1] National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland;John Howard Centre, East London Foundation Trust, Hackney E9 5TD, UK;Edenfield Centre, Manchester, UK;Department of Psychiatry, Trinity College, Dublin, Ireland

关键词: Hospital;    Mental health;    Long term;    Forensic;    Psychiatry;    Length of stay;   

Others  :  1216383
DOI  :  10.1186/s13033-015-0017-7

 received in 2015-03-17, accepted in 2015-06-13,  发布年份 2015

【 摘 要 】

Background

Length of stay in psychiatric hospitals interests health service planners, economists and clinicians. At a systems level it is preferable to study general adult and forensic psychiatric beds together since these are likely to be inter-dependent. We examined whether patients were placed according to specialist need or according to their cross-sectional length of stay.

Methods

A one night census of all registered mental nursing home (RMNH) beds was carried out for a defined catchment area of 1.2 m population in north London in November 1999. This included all public sector psychiatric hospital beds, independent sector and forensic beds in and outside the catchment area. Cross-sectional length of stay was defined as time since the date of admission from the community. Log rank (Mantel-Cox) Chi squared was used to test for differences between groups and hierarchical logistic regression for statistical modelling.

Results

There were 1,085 occupied psychiatric beds. Cross-sectional LOS was greater than 365 days in 43.5%. Forensic beds had longer cross-sectional LOS than general beds. LOS increased with the level of therapeutic security from open through low, medium and high secure. Cross-sectional LOS was shorter for open hospital beds than community RMNH beds, shorter for informal patients than those detained under civil mental health law, and longest for forensic detentions. Longest cross-sectional LOS were for patients placed in RMNHs in the community, 10.7% of whom were ‘forensic’ as were 25.4% of low secure patients. Designated length of stay (acute, rehab/medium term and long term) was also associated with increasing cross-sectional LOS. In regression analysis only three variables contributed to a model of cross-sectional LOS, commissioning status (general or forensic), designated length of stay and designated level of therapeutic security.

Conclusions

Studying cross-sectional LOS for whole systems (all psychiatric beds) is essential for operational health service management. At the time of this survey ‘forensic’ status was the main way of accessing long term high dependency places. This has been an organic development over time, a response to patient needs rather than the outcome of any specific policy or plan.

【 授权许可】

   
2015 Sharma et al.

【 参考文献 】

• [1]Glover G, Farmer R, Preston D. Indicators of mental hospital bed use. Health Trends. 1990; 3:111-115.
• [2]Selvin S. Three statistical models for estimating length of stay. Health Serv Res. 1977; 12(3):322-330.
• [3]Leff J, Knapp M, Hallam A. The TAPS project: a report on 13 years of research 1985–1998. Psychiatr Bull. 2000; 24:165-168.
• [4]Trieman N, Leff J, Glover G. Outcome of long stay psychiatric patients resettled in the community: prospective cohort study. Br Med J. 1999; 319(7201):13-16.
• [5]Wing JK, Brown GW. Institutionalism and Schizophrenia. A comparative study of three mental hospitals 1960–1968. Cambridge University Press, Cambridge; 1970.
• [6]London’s mental health. King’s Fund, London; 1997.
• [7]Lelliot P, Wing J, Clifford P. A national audit of new long-stay psychiatric patients I: method and description of the cohort. Br J Psychiatry. 1994; 165:160-169.
• [8]Shepherd G, Beadsmoore A, Moore C, Hardy P, Muijen M. Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews. Br Med J. 1997; 314:262-274.
• [9]James D. Court diversion at 10 years: can it work, does it work and has it a future? J Forensic Psychiatry. 1999; 10(3):503-520.
• [10]Pierzchniak P, Purchase N, Kennedy HG. Liaison between court, prison and psychiatric services. Health Trends. 1997; 29:26-29.
• [11]de Taranto NE, Bester P, Pierzchniak P, McCallum A, Kennedy HG. Medium secure provision in NHS and private units. J Forensic Psychiatry. 1998; 9:369-378.
• [12]Jones R. Mental Health Act manual. 5th ed. Sweet & Maxwell, London; 1996.
• [13]Kinsley, J. Security and therapy. In: Kaye C, Franey A, editors. Managing high security psychiatric care. London: Jessica Kingsley; 1998.
• [14]Coid J, Kahtan N. An instrument to measure the security needs of patients in medium security. J Forensic Psychiatry. 2000; 11:119-134.
• [15]Kennedy HG. Therapeutic uses of security: mapping forensic mental health services by stratifying risk. Adv Psychiatr Treat. 2002; 8:433-443.
• [16]National Research Ethics Service. Defining research. London, NHS Health Research Authority. 2013. http://www. hra.nhs.uk/research-community/before-you-apply/determine-whether-your-study-is-research
• [17]Jones R. Mental Health Act manual. 5th ed. Sweet & Maxwell, London; 1996.
• [18]IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk: IBM Corp.
• [19]Bryant T. Confidence interval analysis V2.2.0 build 57, University of Southampton. 2011. In: Altman D, Machin D, Bryant T, Gardner S, editors. Statistics with confidence. 2nd edition. London: Wiley, Blackwell; 2000.
• [20]Priest RG, Fineberg N, Merson S, Kurian T. Length of stay of acute psychiatric inpatients: an exponential model. Acta Psychiatr Scand. 1999; 92:315-317.
• [21]Millard PH, McClean, S. Go with the flow. London: Royal Society of Medicine Press; 1996.
• [22]Millard PH, McClean S. Modelling hospital resource use. Royal Society of Medicine Press, London; 1994.
• [23]Malone D, Fineberg NA, Gale TM. What is the usual length of stay in a psychiatric ward? Int J Psychiatry Clin Pract. 2004; 8:53-56.
• [24]Thompson A, Shaw M, Harrisson G, Ho D, Gunnell D. Patterns of hospital admission for adult psychiatric illness in England: analysis of hospital episode statistics data. Br J Psychiatry. 2004; 185:334-341.
• [25]Daly A, Walsh D, Comish J. Activities of Irish psychiatric units and hospitals. Health Research Board, Dublin; 2004.
• [26]Huntley DA, Cho DW, Christman J, Csernansky JG. Predicting length of stay in an acute psychiatric hospital. Psychiatric Serv. 1998; 49:1049-1053.
• [27]Sloan DM, Yokley J, Gottesman H, Schubert DS. A five-year study on the interactive effects of depression and physical illness on psychiatric unit length of stay. Psychosom Med. 1999; 61(1):21-25.
• [28]Cowan C, Walker P. New long-stay patients in a psychiatric admission ward setting. Psychiatr Bull. 2005; 29:452-454.
• [29]Harrison GW, Millard PH. Balancing acute and long-term care: the mathematics of throughput in Departments of Geriatric Medicine. Methods Inf Med. 1991; 30:221-228.
• [30]Flynn G, O’Neill C, McInerney C, Kennedy HG. The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study. BMC Psychiatry. 2011; 11:43. BioMed Central Full Text
• [31]Davoren M, Abidin Z, Naughton L, Gibbons O, Nulty A, Wright B et al.. Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgement instruments and risk. BMC Psychiatry. 2013; 13:185. BioMed Central Full Text
• [32]de Taranto NE, Bester P, Pierzchniak P, McCallum A, Kennedy HG. Medium secure provision in NHS and private units. J Forensic Psychiatry. 1998; 9:369-378.
• [33]Purchase ND, McCallum AK, Kennedy HG. Evaluation of a Psychiatric Court Liaison Scheme in North London . Br Med J. 1996; 313:531-532.
• [34]Grove P, MacCleod J, Godfrey D. Forecasting the prison population. Oper Res Insight. 1998; 11:3-9.