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Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998

Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, 50 Eastbourne Terrace, London W2 6LX and Senior Lecturer in Epidemiology, Department of Epidemiology & Public Health, University College London Medical School, London

Thomas R. E. Barnes, Professor of Clinical Psychiatry

Imperial College School of Medicine, Ealing Hospital, Middlesex

Anna Higgitt, Consultant Psychiatrist and Senior Policy Adviser

Department of Health, London

Chris Molloy, Project Manager and Researcher in Mental Health

Department of Research and Development, Kensington & Chelsea and Westminster Health Authority, 50 Eastbourne Terrace, London W2 6LX

Sally Hargreaves, Director of Performance and Partnerships

Department of Performance and Partnerships, Kensington & Chelsea and Westminster Health Authority, London

Declaration of interest

None.

AIMS AND METHOD

We undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.

RESULTS

Patients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.

CLINICAL IMPLICATIONS

Our findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.

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