While cuts to the number of mental health inpatient beds continues, there is little evidence that the healthcare needs of those with serious mental illnesses are being met elsewhere, according to new research.
In the paper, Hospital Admissions and Community Treatment of Mental Disorders in England from 1998 to 2012, Ben Green, Professor of postgraduate medical education and psychiatry at the University of Chester, highlighted that mental health bed numbers in England fell by 39% from 37,000 in 1998 to 22,300 in 2012.
Alongside Dr Emily Griffiths of North Carolina State University, Professor Green found that admissions for depression, bipolar disorder, schizophrenia, dementia and obsessive compulsive disorder all fell, in line with declining bed numbers.
However, use of the Mental Health Act to compel admission has risen and, against the trend for falling bed numbers admissions for alcoholism and cirrhosis rose significantly across the rest of the NHS in association with increased affordability of alcohol.
'Squeezing out severely depressed'
"Our findings suggest that there is a crisis in psychiatric beds in England that is squeezing out severely depressed patients," said Professor Green.
"Evidence for where these patients are being treated is not clear. GPs may be picking up the extra cases, or maybe not. Despite this trend there are concerning patterns of certain mental illnesses being on the rise.
"Admissions for alcohol-related disorders, physical or mental, increased significantly and this was linked to a rise in patients being admitted with severe liver cirrhosis. This rise in alcohol-related admissions seems linked to the increased affordability of alcohol."
Further reading: Dementia care hit hardest by rising bed demand
Existing national data on the activity of community mental health teams has not been collected in a consistent manner or for a long enough time to enable useful comparisons with hospital episode data, according to the researchers.
They also found that admissions were declining for conditions like depression. By 2012, the annual admissions rate for depression had fallen by 50% compared to 1998, which meant that every year 15,000 ‘hospital grade’ cases of depression were not being admitted that would have been in 1998.
Rise in demand for mental health care
Professor Green called for further research to examine how the change in hospital admissions affects the general public and primary care providers.
“Pressures caused by having fewer and fewer mental health beds could have resulted in a rise in demand for care for mental illness placed on GPs – particularly for cases of severe depression, with primary care carrying associated risks of suicide, self-harm and so on,” he added.
“It could also have increased the burden of care for patients on their friends and families. Especially concerning is that there may ever more unmet mental health needs where patients are not being treated, particularly those with ‘hospital grade’ depression.
“We urgently need more longitudinal studies on the patterns, causes and effects of unmet mental health needs. Public release of NHS data should continue and be strengthened. In particular, we need consistent publication of community mental health team activity by diagnosis. This would determine if additional staff, resources or training are needed for those working in the frontline of primary care.”