A study on involuntary admission to psychiatric wards in the UK over a 20 year period

The only two things which are interesting in this study are:
"The rate of involuntary admissions per annum in the NHS
increased by more than 60%, whereas the provision of mental illness
beds decreased by more than 60% over the same period; these changes
seemed to be synchronous."

Association between provision of mental illness beds
and rate of involuntary admissions in the NHS in
England 1988-2008: ecological study
British Medical Journal
http://press.psprings.co.uk/bmj/july/beds.pdf

The study authors make few conclusions and it's hard to from the data they have available.

I'm surprised that they didn't consider looking at first time admissions versus repeat admissions. Perhaps this data wasn't available from the NHS Information Centre or perhaps they didn't think to consider it. I'd also be interested to know if the rate of voluntary admission had changed. This data may not be relevant to the study but it's interesting nonetheless.

The reduction in the number of available beds means more people were looked after in the community. If these people became unwell again then they'd be readmitted so this would probably account for the rise in admissions.

The authors of the paper summarily dismiss the idea that mental disorder has risen during the 20 years covered. The evidence for this would be in the rate of first admissions, i.e. if mental disorder rose or the circumstances which lead to involuntary admission changed to covered more people then this would be reflected in an increase in first admissions.

The authors must have thought of this. I'm not that smart and medical researchers can't be that stupid.

What's also interesting is this text.
"Regression analysis indicated that the
closure of two mental illness beds was associated with one
additional civil involuntary admission in the subsequent year."

And also this text
"Between 1988 and 2008 the provision of mental illness beds in
the NHS decreased by 62%, from 166.1 to 63.2 per 100 000
adults (total numbers decreased from 63 012 to 26 430; fig 1).
During the same period the rate of involuntary admissions
increased by 64%, from 40.2 to 65.7 per 100 000 adults per
annum and exceeded bed provision by the end of the study
period"

At the end of the study period is around the time the Community Treatment Order was introduced into the medico-legal framework when the Mental Health Act was revised. This was aimed at reducing the number of 'revolving doors' patients (the term given to those who would leave hospital but be readmitted within a year.

The protocol was overused by an estimated 1000% in the first year. Give psychiatry a new tool of oppression and it would use it like a barbarian with a new cudgel.