Delays and disparities in access to secure psychiatric services in England: national study of referrals and access assessments

Le résumé fourni par la source

BACKGROUND: Secure psychiatric services (SPS) are vital for people with severe mental disorders who pose significant risks, yet national evidence on referral pathways, acceptance and timeliness of admission is limited. Delays and variability in access are especially concerning in prisons, where mental health crises are frequent and alternatives limited. AIMS: This study presents the first national analysis of SPS referral and admission patterns in England following the introduction of provider collaboratives. It identifies predictors of referral acceptance and delays across the referral-to-admission pathway to inform equity and performance improvement. METHOD: Data were drawn from 149 low-secure and 98 medium-secure services across 15 provider collaboratives, encompassing 1356 referrals. Multivariable models examined predictors of acceptance and delay, benchmarked against national policy standards. RESULTS: = 529), with 55% accepted. Acceptance was associated with gender, legal status, Mental Health Act status, prior secure admission, diagnosis, referral origin and reason for referral, but not with ethnicity or urgency. Substantial site-level variation reflected local practice and resources. Delays were widespread: fewer than a third of urgent referrals were assessed within 2 days, and only 19-25% of accepted prison referrals met recommended assessment and admission targets. Although prison referrals were processed more quickly than community or SPS referrals, national standards were seldom achieved. CONCLUSIONS: Access to SPS remains inconsistent, with substantial variation in acceptance and widespread delays across referral pathways. Despite faster processing of prison referrals, national assessment and admission standards were rarely met, particularly for this group. These findings highlight gaps between policy expectations and practice, indicating a need for improved adherence to national timeframes, greater standardisation of decision-making and enhanced system oversight, to reduce inequities in access.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.