Trends in alcohol and drug admissions to psychiatric facilities.
Drugnet Ireland, Issue
Activities of Irish psychiatric units and hospitals 2007, the annual report published by the Mental Health Research Unit of the Health Research Board in December 2008, shows that the total number of admissions to inpatient care has continued to fall.1
In 2007, 2,699 cases were admitted to psychiatric facilities with an alcohol disorder, of whom 808 were treated for the first time.1 Figure 1 presents the rates of first admission between 1990 and 2007 of cases with a diagnosis of alcohol disorder, per 100,000 of the population.1-6 It is notable that the rate decreased steadily between 1991 and 2004 and more than halved during the reporting period. The rate stabilised in 2004 and 2005, but decreased again in 2006 and 2007. The trend since the early nineties reflects changes in alcohol treatment policy and practice, and the resultant increase in community-based and special residential alcohol treatment services. Of the 2,743 discharges with an alcohol disorder, just under 44% spent less than one week in hospital and 17% spent more than one month in hospital. Whether or not these admissions were appropriate, and in line with the recommendations of the mental health policy, A vision for change, could not be discerned from the report as the numbers with co-morbid illness were not reported.
In 2006, 724 cases were admitted to psychiatric facilities with a drug disorder, of whom 265 were treated for the first time.1 The report does not present data on drug use and psychiatric co-morbidity, so it is not possible to determine whether or not these admissions were appropriate. Figure 2 presents the rates of first admission between 1990 and 2007 of cases with a diagnosis of drug disorder, per 100,000 of the population.1-6 The rate increased steadily between 1990 and 1995, with a dip in 1996, and further annual increases between 1997 and 2001. The rate was almost three times higher in 2001 than it was in 1990. Notable dips in the rate occur in the census years 1996 and 2002, and can be partly explained by the increased population figure used as the denominator in calculating the rate for those years.
The overall increase in the rate of drug-related first admissions between 1990 and 2001 reflects the increase in problem drug use in Ireland and its burden on the psychiatric services. The overall decrease in the rate since 2001 possibly reflects an increase in community-based specialised addiction services during this period. The increased rate in 2005 may be accounted for by the use of the 2002 census figure in calculating the rate. The decrease to 5.9 in 2006 reflects the new census figure used as denominator. The rate increased marginally to 6.3 in 2007. Of the 776 discharges with a drug disorder, 51% spent less than one week in hospital and just under 13% spent more than one month in hospital.
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