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Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996

Department of Psychological Medicine, Guy's, King's and St Thomas' Medical School, London

Declaration of interest Funded by the Department of Health.

Correspondence: Dr Matthew Hotopf, Department of Psychological Medicine, Guy's, King's and St Thomas' Medical School, 103 Denmark Hill, London SE5 8AZ. Tel. 02071740 5073; Fax: 0207740 5129; e-mail: mhotopf{at}iop.bpmf.ac.uk

Background The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future.

Aims To explore changes in the use of the Act since its introduction.

Method The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data.

Results Formal admissions rose from 16 044 in 1984 to 26 308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part x of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s.

Conclusions Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.

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