Psychiatric inpatient admissions and discharges of people with intellectual disabilities: A time series analysis of English national data.
Peter E Langdon, Paul A Thompson, Lee Shepstone and 6 others
PMID 36380661WHAT IT FOUND
Inpatient numbers for people with intellectual disabilities in England fell by 21-24%, missing the 35-50% target.
Community nursing staff declined sharply. Care and treatment reviews were associated with more admissions, though post-admission reviews linked to more discharges.
Key findings
01The number of inpatients decreased by 21% (uncorrected data) or 24% (corrected data) between December 2013 and March 2021, falling short of the 35-50% reduction target.
02Community intellectual disability nurses declined by 20% and support staff by 34% over the same period, while consultant psychiatrist numbers remained stable.
03Pre-admission care and treatment reviews (CTRs) were associated with increased admissions and a higher admission-to-discharge ratio, while post-admission CTRs were associated with more discharges but did not reduce total inpatient numbers.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The study is observational and correlational; it cannot prove that CTRs or workforce changes caused the shifts in admission or discharge rates. Community nurses were excluded from the final models due to collinearity with other variables, so their specific impact on outcomes could not be assessed. Data were limited to monthly counts, preventing analysis of individual patient factors or outcomes like readmission rates. The dataset covers only England and may not reflect international practices or local variations within the country.
Declared interests
None declared.
The easy way to misread this
Do not assume that Care and Treatment Reviews (CTRs) are failing to reduce inpatient numbers. While pre-admission CTRs were associated with more admissions, this likely reflects the requirement for a CTR before admission, not that the review itself causes admission. The lack of reduction in total inpatient numbers despite CTR use highlights broader system issues, such as workforce shortages, rather than the ineffectiveness of the review process itself.