Patterns of use of mental health crisis-related services in the English NHS: retrospective observational study

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BACKGROUND: Improving access to community-based crisis care and reducing in-patient admissions are key policy objectives in England, yet evidence on who uses crisis-related services remains limited. AIMS: To examine sociodemographic patterns in the use of six crisis-related services in England: crisis phonelines; crisis cafés; Crisis Resolution and Home Treatment teams (CRHTs); voluntary in-patient admissions; compulsory in-patient admissions under the Mental Health Act 1983 (MHA); and conveyance to a Place of Safety (PoS) by police under section 136 of the MHA. METHOD: This retrospective observational study used the Mental Health Services Data Set (2021/2022-2023/2024). Adults (18+ years) using any of the six services were included. A multinomial logit regression model estimated average marginal effects for age, gender, ethnicity and area-level deprivation, with robust patient-level standard errors and year fixed effects. RESULTS: Among crisis-related patients, adjusted analysis showed that several ethnic minority groups were more likely than White individuals to be compulsorily detained or brought to a PoS, and less likely to use CRHTs, with the largest disparities in compulsory admissions for Black (+15.0 percentage points) and Asian (+7.3 percentage points) groups. Compulsory admissions were more common among older adults and men (+1.5 percentage points). Crisis phonelines were used less by older adults, men (-4.8 percentage points), Black (-15.6 percentage points) and Asian (-4.7 percentage points) groups. Although adjusted differences by deprivation were small (<1.0 percentage points), over half of users lived in the 2 most deprived quintiles. CONCLUSIONS: Groups at greater risk of coercive care were less likely to access community crisis services. Addressing these disparities could reduce inequalities.

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