Specialist psychiatric bed utilisation by people with intellectual disabilities and autistic people: A time-series analysis using the English Assuring Transformation dataset

Background: Using nationally available anonymised and aggregated English data, we examined specialist and nonspecialist psychiatric bed utilisation by people with intellectual disabilities and/or autism. Methods: Using data about specialist psychiatric bed utilisation from the Assuring Transformation Dataset, from March 2015 to January 2024, we applied linear regression (with moving average or autoregressive errors) to explore the relationships between a set of outcome variables (e.g., number of inpatients and length of stay) and a set of sociodemographic, clinical and service-related predictor variables (e.g., age, ethnicity, admission source, legal status, admission source, discharge destination, Care (Education) and Treatment Reviews) over time. Comparisons were made with data from the Mental Health Services Data Set about nonspecialist psychiatric bed utilisation. Results: Over time, there was an average reduction of 8.07 inpatients per month. This reduction was due to a reduction in the number with a length of stay longer than 2 years, and fewer inpatients with intellectual disabilities without autism over time, rather than fewer autistic inpatients without intellectual disabilities; instead, the number of autistic inpatients increased by 6.02 per month. However, overall, there were fewer inpatients in specialist psychiatric beds than in nonspecialist beds by an average of 877 patients, and the number in specialist beds reduced faster than the number in nonspecialist beds over time. We found that more hospital spells were associated with more inpatients older than 18, more detentions under Part III of the Mental Health Act, more inpatients not known to the local authority, and an increased number of White inpatients. More admissions were associated with fewer discharges, while those with a hospital stay longer than 2 years were less likely to have had a postadmission Care (Education) and Treatment Reviews and were more likely to use advocacy. Conclusions: The number of inpatients with intellectual disabilities in specialist psychiatric beds continues to decline over time, while the number of autistic inpatients without intellectual disabilities is increasing. Future research should utilise participant-level data to explore patient long-term trajectories.