Predicting admission rates to secure forensic psychiatry services

Area of Science:

• Forensic Psychiatry
• Public Health
• Health Services Research

Background:

• Secure forensic psychiatry services in England and Wales developed regionally.
• Socio-economic deprivation and social disorganization correlate with mental disorders and offending.
• Current service provision is inequitable due to unaddressed socio-economic factors.

Purpose of the Study:

• Develop a model to predict admissions to secure forensic psychiatric services.
• Aid in equitable resource allocation for these services.
• Address disparities in service provision linked to socio-economic factors.

Main Methods:

• Analyzed actual admissions (N=3155) to high and medium secure services (1988-1994).
• Calculated expected admissions using 1991 census data, adjusted for under-enumeration.
• Used regression analysis with social, health, and service data to explain admission variations.

Main Results:

• Actual admissions varied significantly (160% above to 62% below expected) by catchment area.
• Socio-economic deprivation, ethnicity, and low secure bed availability were key predictors.
• Admission rates showed a linear correlation with socio-economic deprivation levels.

Conclusions:

• Admission rates to secure forensic services are linearly correlated with area socio-economic deprivation.
• A predictive model for District Health Authorities is recommended for resource allocation.
• Further research is needed to understand factors driving higher admission rates in deprived areas.