Poverty, poor services, and compulsory psychiatric admission in England.
BACKGROUND
Compulsory admission is a central feature of psychiatric systems internationally but the factors determining its use within different legal systems are not understood. Numbers of compulsory psychiatric admissions vary widely between areas in England. We examined the hypothesis that variation in rates of detention is related to social deprivation and also to the functioning of local mental health services.


METHODS
Rates of detention under sections 2 and 3 of the Mental Health Act (1983) in 1998/9 were obtained in 34 mental health sectors in eight Trusts in England. Measures of socio-economic deprivation and measures of service function were used to conduct an ecological analysis.


RESULTS
Compulsory admission is associated with measures of deprivation but there is unexplained variation. The range in rates is higher than allowed for by the resource allocation formula. Some indicators of service quality are independently associated with rates of detention.


CONCLUSIONS
Variation in detention rates and its relation to service function need further explanation if the use of compulsion is to be reduced.
Section of Community Psychiatry (PRiSM), Health Services Research Department, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. j.bindman@iop.kcl.ac.uk
Jonathan
J
Bindman
James
J
Tighe
Graham
G
Thornicroft
Morven
M
Leese
D000293:Adolescent; D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003156:Community Mental Health Services; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D011787:Quality of Health Care; D012044:Regression Analysis; D012306:Risk