Abstract
Aims and methodWe examined the local impact of introducing a home treatment team on the use of in-patient psychiatric resources and rates of detention under the Mental Health (Care and Treatment) (Scotland) Act 2003.ResultsRates of admission to hospital and duration of hospital stay were unchanged. However, there was an increase in episodes of detention in the year following the team's introduction.Clinical implicationsOffering home treatment as an alternative to in-patient care may be associated with an increase in compulsory treatment. If true, this is incompatible with the ‘least restrictive alternative’ principle of the recently revised mental health legislation.
Highlights
The proportion of compulsory admissions increased, but we found an unexpected increase in the absolute number of people subject to detention under the Mental Health (Care and Treatment) (Scotland) Act 2003
The service redesign and introduction of the intensive home treatment team (IHTT) in Midlothian has not been associated with reduced admission numbers or length of hospital stay
The introduction of the IHTT was associated with a reduction in average bed occupancy, which may be explained by the presence of a cohort of in-patients, with long hospital stays at the start of the 2006-2007 period
Summary
Admission rates did not differ markedly across the two time periods, a larger proportion of individuals were detained at some point during their admission in the 20072008 period (Fig.[1]). For both time periods, the median length of stay in hospital was 9 nights; the mean length of stay was nights in the 2006-2007 period and nights in the 2007-2008 period. The average number of beds occupied per night dropped from 9 in the 2006-2007 period to 6 in the 2007-2008 period This may be partly explained by the presence of 16 people with prolonged stays in hospital at the start of the 2006-2007 period, versus only 2 individuals in hospital at the start of the corresponding period in 2007-2008. Upon examining the data further, we found marked increases in the rates of all civil compulsory orders (both hospital- and community-based) in the year following redesign (Fig. 2)
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