Effects of Patient and Health-System Characteristics on Community Tenure of Discharged Psychiatric Inpatients

Abstract

6 68 85 5 O ver the past two decades, the organization and provision of mental health care have changed dramatically. The deinstitutionalization of mental health services has resulted in shorter stays in psychiatric hospitals and in larger numbers of psychiatric patients living in the community (1). Many communities have too few resources to help these patients (2). The number of psychiatric referrals to hospital emergency departments has increased, partly because of the general lack of linkage between institutional and community services (3). This trend has been observed both in the United States and in Europe (4).Previous research has provided consistent evidence that persons with previous use of psychiatric services are among the most frequent users of psychiatric emergency departments (5-10). Moreover, patients who are readmitted to inpatient psychiatric care are often found to have been recently discharged from a psychiatric hospitalization. In previous studies, 24 percent of 262 patients (11) and 38 percent of 128 patients (12) with a recent hospital discharge were readmitted within three to six months. In a study of state hospital patients in Massachusetts, Fisher and colleagues (13) found a 50 percent readmission rate within four years of discharge among 5,610 patients. Early hospital readmission has been related to the presence of mental illnesses with poor prognoses (13-15), to poor quality of patients' social networks, and to patients' difficulties with hygiene at discharge (16).Early readmissions, however, may also reflect the quality of postdischarge treatment and care. Some unplanned psychiatric referrals could be explained by the unexpected and acute progression of the patient's mental illness, but the rest may result because the mentally ill person has been discharged from the hospital too soon or because follow-up in the community is ineffective.Lower readmission rates have been associated with the existence of follow-up services. For example, McIntosh and Worley (17) implemented telephone follow-up and aftercare groups for patients who were discharged from a psychiatric hospitalization. Fifteen months after the implementation of these services, these authors found a readmission rate of

Who Comes Back? Characteristics and Predictors of Return to Emergency Department Services for Pediatric Mental Health Care

“…The characterization of clinical features over the course of service use is also lacking. Given that many return ED users already have access to mental health services, 41,[51][52][53][54] such studies would help to clarify the role of the ED along the service and illness continuums.…”

Hand Hygiene Compliance Among Health Care Staff and Student Nurses in a Mental Health Setting

“…Hygiene does not appear to be of the utmost importance to these patients. Additionally, there is consistent evidence that patients with a mental health illness are among the highest users of emergency and hospital care; a trend toward deinstitutionalization and community care for this population has resulted in increased use of acute medical and specialized services (Bruffaerts, Sabbe, & Demyttenaere, 2004). The rates of recidivism in the patient with chronic mental health disability can be as high as 55% (Bruffaerts et al, 2004;Dhossche & Ghani, 1998).…”

The supplement to Developing the Psychiatric Nurse Job Stressor Scale

“…When the length of hospital stay becomes prolonged, patients become highly susceptible to "hospitalism" that includes weakened self-care ability [25]. Moreover, patients sometimes stop taking their medications after leaving the hospital [26], and patients that have been discharged from psychiatric wards have a high likelihood of being readmitted soon after [27]. These findings suggest that PNs have difficulty assessing hospital discharge for psychiatric patients or providing support that foresees their lifestyle after discharge.…”