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Background: Monitoring and researching clinical care calls for comprehensive clinical databases. In mental health care these need to cover all aspects of the care of each patient and to accommodate the complexity of care which may last from weeks to years. This paper describes the pilot work for a mental health clinical database intended to be implemented throughout the English National Health Service. Methods: In collaboration with three pilot sites, a set of data extracts was defined which could reasonably easily be produced, mostly using existing statistical data collection systems. Software was designed to integrate these extracts into patient-based records describing overall spells of mental health care. These data were extracted from their systems for a 6-month pilot period. Results: Two of the three sites produced data sets, which appeared to give a reasonably complete account of the work undertaken in the pilot period. Known differences in service design and clinical perspective between the two sites were clearly reflected. Conclusions: The approach to extracting and collating the data is workable within existing resources and produces illuminating data for clinical audit, management and planning. Completeness and accuracy of data is likely to be a continuing problem, as for any routine data capture exercise. However, the process of integrating data from several channels assists this, as inconsistencies become apparent and can be tackled. The approach is now being implemented throughout England.

For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.

Work in the 1980s has shown that the high incidence of schizophrenia in British Caribbean men is restricted to those born after 1950. Data from a study of admissions in three London health districts suggested that the greater part of this excess risk may be confined to those born before 1966. This suggests that the group of British Caribbean men experiencing a high frequency of schizophrenia could be a tightly delineated birth cohort. If confirmed in wider studies, this could have important implications for the elucidation of the causes of one type of schizophrenia.

Background: This study formed part of the background work for the development work of a new Mental Health Minimum Data Set in England. It surveyed the range and nature of information systems currently used by English mental health care provider Trusts. It also surveyed relevant aspects of their organisational arrangements. Method: Information was collected by a telephone survey of Trust information and clinical service managers. Results: Most Trusts have a complex array of different information systems – the median number is four. Even where fully integrated systems are in place, these do not necessarily cover all data areas over the whole of the Trust's operations. Sixty-three percent of Trusts use more than one patient numbering system. Sixty-percent have implemented or formally piloted routine collection of outcome scoring, 51% using the Health of the Nation Outcome Scale (HoNOS). A simple model suggested that the proposed data set could realistically be implemented nationally over a 4-year timescale. Conclusions: Given the current information system context and planned developments it would be realistic to implement the proposed Mental Health Minimum Data Set over a 4-year timescale.

The study aimed to develop a mental illness needs index to help local managers, district purchasers and national policy makers in allocating resources. Formulae were developed by regression analysis using 1991 census data to predict the period prevalence of acute psychiatric admission from electoral wards. Census variables used were chosen on the basis of an established association with mental illness rates. Data from one English Health Service region were analysed for patterns common to wards at hospital catchment area level and patterns common to district health authorities at regional level. The North East Thames region was chosen as the setting for the study, with 7096 patients being admitted during 1991. In most, but not all, catchment areas reasonable prediction of the pattern of admission prevalence was possible using the variables chosen. However, different population characteristics predicted admission prevalence in rural and urban areas. Prediction methods based on one or two variables are thus unlikely to work in both settings. A Mental Illness Needs Index (MINI) based on social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing predicted differences in admission prevalence between wards at catchment area level better than Jarman's Underprivileged Area (UPA) score [1] and between districts at regional level better than the UPA score and comparably to the York Psychiatric Index [2] (adjusted r2 at regional level (MINI 0.82, UPA 0.53, York index 0.70). District admission prevalence rates vary by a factor of three between rural and inner city areas; this difference may not fully reflect the variation in the cost of providing care. It did not prove possible to incorporate factors related to bed availability in the models used; reasons for this are discussed. Data covering other aspects of mental health care in addition to hospital admission are needed for more satisfactory modelling.

BackgroundThere is pressure on acute admission services in inner-city areas. Two deprived London districts with markedly different acute bed ratios but similar sociodemographic backgrounds were compared to test the hypothesis that more facilities mean better service.MethodAn instrument for auditing the use of short-stay hospital beds was constructed to collect information concerning admissions to, and short-stay patients in, the chosen districts during a three-month period.ResultsThere was a higher admission rate and substantially greater use of beds per unit population in south Southwark than in Hammersmith & Fulham. Much of the difference was attributable to a higher rate of admission of patients with affective disorders in south Southwark.ConclusionsThe results are not explained by variations in population need, longer in-patient stay, or poorer aftercare leading to early relapse. The question of whether there is over-provision of services compared with real need in south Southwark, or under-provision (particularly for people with affective disorders) in Hammersmith & Fulham, is considered but left open for discussion following a study of ethnic issues and the reasons for admission.

BackgroundTwenty-six per cent of patients in two Inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors.MethodSampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex.ResultsThere were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizophrenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association.ConclusionsEthnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission.

BackgroundIn this series, rates of admission and daily bed use in south Southwark were 30% higher than in Hammersmith & Fulham, principally because of a higher rate of admission for affective disorders. Factors associated with compulsory admission did not differ between the districts. This final paper examines the severity of symptoms, the reasons given for admission and factors relevant to the judgement to admit, in order to test the hypothesis that more resources mean better service.MethodSampling and data collection methods were described in the first paper.ResultsIn both districts, major reasons for admission were self-neglect and risk of self-harm, poor adaptive functioning, and poor acceptance of medication. In south Southwark, a group of patients had affective disorders and less severe symptoms but a stated risk of suicide. Rates for, and severity of, schizophrenia were similar in the two districts. Social and preventive reasons for admission were given more frequently in south Southwark, where patients had more often been in contact with services before admission. Staff there, but not in Hammersmith & Fulham, suggested that many could have benefited from alternative forms of residential care.ConclusionsA ‘buffer’ of hospital beds in south Southwark may have allowed a more acceptable service, particularly for affective disorders. The possibility that this buffer could be replaced by a wider range of residential accommodation, including hostels away from the District General Hospital, is discussed. Ten recommendations are listed.

The Department of Health and the Royal College of Psychiatrists do not see eye to eye over the introduction of supervision registers for patients in the community who are judged to be at risk. In a recent exchange of correspondence the college expressed “strong concerns” about guidelines issued by the department for the introduction of the register on 1 October. Further discussions are planned, but the differences will not easily be resolved. The issue is much more than a little local difficulty between psychiatrists and the Department of Health; its resolution will be important for all mental health profesionals and for purchasers of psychiatric services. The college is concerned that the criteria for including patients on supervison registers are too broad and about the substantial costs of setting up and servicing the registers. It is also worried about the unclear arragements for withdrawing patients from a register once they have been placed on it and the implications for patients' civil liberties-and about the legal position facing clinician and trusts in the event of a serious assault or suicide of a patient. The Department of Health disagrees that concern is justified. The secretary of state denies that the criteria for inclusion are too broad, refuses to accept that the introduction of the registers implies the need for any new services requiring additional expenditure, and asserts that the proposed conditions for removing patients from the register are perfectly clear. She has avoided any detailed discussion of the college's concern about civil liberties and on the legal position has asserted that the introduction …

Recent work strongly suggests a high prevalence of schizophrenia in young Caribbean men in the UK. While the aetiology of schizophrenia is not clear, it appears to have an organic basis. The hereditary patterns that have been described do not account for the pattern observed. Alternative explanations, including the possible influence of infectious agents, are being discussed.

Routine DHSS data show that in London, Jamaicans have higher psychiatric admission rates than Barbadians or Trinidadians. A higher proportion of admissions of Jamaican and Barbadian men receive a diagnosis of schizophrenia while a higher proportion of Trinidadians are diagnosed as affective disorders.