Are Patients Improving during and after a Psychiatric Hospitalisation? Continuity of Care Outcomes of Compulsory and Voluntary Admissions to an Italian Psychiatric Ward

Abstract

Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and follow-up in mental health services (MHS) based on community continuity of care.Design and Method: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed up for six months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement.Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2.Conclusion: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that community-based MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received person-centred interventions.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study

“…One wonders whether intervening in these cases necessarily corresponds to a forced hospitalization in a psychiatric facility or if it is possible to carry out other types of treatment, for example by carrying out a home intervention over a medium-short period (days or a few weeks). Forced hospitalization is a violent tool for those who are subjected to it, and often the patient's rehabilitation measures do not allow them to find a home with their family that can accommodate them once hospitalization is over (49)(50)(51) The hope for the future is to be to be able to nourish and nurture a global model of community mental health intervention (52) by training professional staff in a holistic conception of mental distress and social stigma (53-55), also educating society to request and integrate psychiatric and psychosocial interventions (56) with support from the third sector, ensuring the continuity of care in the family and community after discharge from hospitals.…”

Involuntary Psychiatric Treatment during the Covid-19 Pandemic. An international qualitative study.

“…One wonders whether intervening in these cases necessarily corresponds to a forced hospitalization in a psychiatric facility or if it was possible to carry out other types of treatment, for example by carrying out a home intervention over a medium-short period (days or a few weeks). The forced hospitalization is a tool experienced in a violent way by those who are subjected to it, and often the patient's rehabilitation measures do not allow the patient to nd a home in his or her family that can accommodate them once hospitalization is over [39,40,41] The hope for the future would be to be able to nourish and nurture a global model of community mental health intervention [42] by training professional staff in a holistic conception of mental distress and educating society to request and integrate psychiatric interventions [43] with support from the third sector, ascertaining the continuity of care in the family and community after discharge from hospitals.…”