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Aims.Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary).Methods.Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge.Results.Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes.Conclusions.Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.

Smoking and relapse rates indicate a need for increased efforts to reduce smoking during pregnancy and postpartum. Reported intention to quit or resume does not reflect the high number of relapses. Indicators for relapse need to be found.

Little is known about the motivational background of smoking after a period of nicotine abstinence during pregnancy. The study examines the intention to resume smoking (IRS) in the post-partum period and its predictive value for smoking within 12 months post-partum. In a sample of 301 women recruited from obstetric wards who reported having stopped smoking during pregnancy, data on IRS, sociodemographic variables, recent smoking behaviour and smoking in the social network were collected. Smoking status was assessed 6 and 12 months after pregnancy. Among all formerly smoking women, 39 (13%) intended to resume smoking and 262 (87%) intended to maintain abstinence. Women with IRS returned to smoking more often than women without IRS [77 versus 45%, odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.89-9.05]. In a logistic regression model, IRS (OR = 3.7, 95% CI: 1.51-9.01) and number of months currently abstinent (OR = 0.9, 95% CI: 0.76-0.96) attained statistical significance. IRS proved to be the main predictor for relapse; yet, women with no IRS are at risk to restart smoking again, too. IRS offers a cue for tailoring interventions.

There is considerable overlap between the clientele of psychiatric and psychosomatic units. Referral and allocation appears to be determined by aspects of severity and social status.