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The purpose of this paper is to evaluate the impact on recovery and personal goal attainment of a transition intervention service for return to the community following exit from an alternative to psychiatric inpatient admission – a residential recovery house. The services seek to facilitate community reintegration, promote recovery and prevent future mental health crisis. The service was funded by the Stone Family Foundation.

This evaluation employed a within groups design: a single case evaluation follow-up. Analysis of Recovery Star and personal goal achievement data collected at service entry and exit points during routine practice (n=181), at four sites in England. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder.

There was a significant increase in overall Recovery Star scores with a large effect size, and significant increases in eight of the ten Recovery Star life domains. There were significant increases in the goal scores linked to “Managing mental health”, “Self-care” and “Living skills”.

A transitional intervention service provided by the third sector for return to community following mental health crisis may contribute to recovery and personal goal achievement. A randomised control trial of this transition intervention service is recommended.

This is first outcome evaluation of an alternative to psychiatric inpatient admission transition intervention service and findings indicate the potential positive effect of having this service incorporated into the design of alternative to admission provision.

The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal.

A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included.

There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased.

This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal.

The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissions to the unit between 1999 and 2007 (n=167). Mean changes in HoNOSCA scores were analysed, and the predictors of HoNOSCA mean change were assessed using regression analysis. The results showed that the mean length of stay at the unit was 5.6 months (SD 3.1). PCS ratings identified high total, clinical, and environmental complexity scores. HoNOSCA ratings indicated high levels of psychological problems on admission and significant improvement at discharge (mean change 7.7 (SD 6.7)). Greater positive change was associated with higher initial HoNOSCA scores, diagnoses other than conduct disorder and schizophrenia, and a facilitative parental attitude. The authors conclude that the systematic use of standardised outcome measures in child psychiatric inpatient units is useful to document clinical features, complexity and clinical change.

This paper looks at the evolving nature of mental health services. While there has been a shift from asylums to care in the community in recent decades, what is now needed is another shift of acute inpatient psychiatric care, away from psychiatric units to community hospitals and other community settings. It is argued that this would be a further step forward in the evolution of mental health services as it would benefit the service users, their families, carers and staff working in acute psychiatric inpatient units.

The purpose of this paper is to analyse ratings data from the recently developed Learning Disability Needs Assessment Tool (LDNAT) to identify factors associated with specialist intellectual disability (ID) hospital admissions.

Ratings from 1,692 individuals were analysed and the LDNAT items differing significantly between inpatients and non-inpatients were identified. Statistical analyses on total scores derived from these items were used to calculate an optimal cut-off. This LDNAT inpatient index score was also confirmed via an alternative statistical technique.

On average, 18 of the 23 LDNAT item ratings were significantly higher in people with ID assessed as inpatients compared to those rated in community settings. Using the total of these items, the resulting LDNAT inpatient index was analysed. A cut-off score of 22.5 was calculated to be the optimal balance between sensitivity (0.833) and specificity (0.750). This was confirmed by calculating the Youden index (j=0.583). At this level 68 per cent of inpatients and 81 per cent of non-inpatient cases were correctly identified.

Currently there is a national (UK) programme to radically reduce the amount of specialist inpatient care for people ID. This will necessitate early identification of individuals most at risk of admission together with investment in improved, proactive community services if admissions to a diminishing bed-base are to remain manageable.

This study confirms the associations between mental health difficulties, challenging behaviour and specialist hospital admissions for people with ID, extending existing research by translating these findings into a clinically usable risk index.

The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission.

Secondary analysis of data submitted as part of the Transforming Care programme in England.

2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities.

Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis.

The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives.

This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission.

Behavioural activation is a contemporary behavioural treatment for depression that has the potential advantages of being more readily adopted in psychiatric inpatient environments than more complex psychological treatment approaches and requiring less intensive training than these approaches. In this article the theoretical and empirical foundations of behavioural activation are described along with an outline of the therapeutic process and key interventions used. Consideration is then given to factors influencing the implementation of BA in psychiatric inpatient environments.

In this article we explore how inpatient mental health services in England and Wales are interpreting and responding to policy derived from Mainstreaming Gender and Women's Mental Health (DH, 2003) in relation to women's safety in inpatient settings. This article will outline the background to concerns about safety in mental health settings for women and drawing on relevant literature and on interviews with service managers, practitioners and users identify some current issues in improving safety for women in inpatient settings and in creating single sex provision. Our review suggests that whilst there are improvements in provision for women in inpatient settings, some women are still not being offered a real choice of a women‐only setting on admission to hospital, and that changing the culture that permits a lack of physical and relational safety for women presents real challenges. We will discuss some of the implications for future practice.

The purpose of this study was to explore the predictive validity of the revised Problem Identification Checklist (PIC‐R) in predicting inpatient and community violence using a retrospective design. The Historical Scale (H‐Scale) of the HCR‐20 was employed to control for static risk factors. The predictive accuracy between predictors and outcome measures was evaluated using Receiver Operating Characteristics (ROC) analysis. The PIC‐R significantly predicted inpatient violence (AUC range 0.77‐0.92) over a 12‐month follow‐up period but did not predict community violence. Conversely, the H‐Scale significantly predicted community violence (AUC 0.82) but did not predict inpatient violence over a 12‐month follow‐up period. The findings offer preliminary validation for the predictive accuracy of the PIC‐R for violence in a UK inpatient population. Additionally, the findings suggest that short‐term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables rather than to static ones.

Despite contemporary mental health services shifting to a community‐based model of care, acute inpatient care is still necessary for many patients experiencing an acute psychological crisis. As inpatient services cost the National Health Service nearly £600 million a year, initiatives to reduce time spent in hospital, whilst maintaining safety and quality, are being actively promoted on a national level. Mental health patients in Hertfordshire spend on average two weeks in hospital during their acute crisis. The aim of this study is to reduce bed occupancy rates by implementing a novel approach to inpatient management.

A pragmatic controlled clinical trial design was used to address the aim of this study.

The results demonstrate that, compared to a functionalized inpatient ward (one with a designated inpatient consultant psychiatrist conducting a weekly ward round), it is possible to reduce bed occupancy rates without increasing demand on other wards. Furthermore, 28‐day readmission rates and total admissions over seven days were reduced.

Limitations relating to the study design and potential generalisability to similar services are discussed. Further studies to triangulate the data are suggested.

This novel approach to inpatient management provides exciting data that suggest patients can be moved along the acute pathway more efficiently. Recommendations for further studies are made in light of the findings.

This paper will appeal to acute care clinicians, service managers, and commissioners of mental health services. It provides an evidence base for making efficiencies within the acute service whilst maintaining quality of care for patients.