Follow-Up after Inpatient Psychiatric Hospitalization with Partial Control of the System Responsiveness Variable

Abstract

One of the most significant predictors of prompt rehospitalization following psychiatric hospital discharge is missing follow-up out-patient appointments. Previous studies have suggested that system responsiveness accounted for much of the variance in predicting compliance with aftercare. Collaborations established at our institution allowed us to partially control this variable, opening the way to explore other obstacles to aftercare. All severely mentally ill subjects discharged from our hospital are provided follow-up appointments within two weeks. We retrospectively evaluated compliance with aftercare appointment and investigated factors that were associated with compliance. Eighty-one subjects were evaluated. Twenty-seven (33.8 %) did not attend their first follow-up appointment. Subjects with a primary substance-related syndrome were the most likely to miss their appointment (83.3%, chi 2 = 17.02, p = .0045), as were uninsured patients (51.6%, chi 2 = 8.79, p = .003). There was a trend for individuals not previously involved with their aftercare providers to miss their appointment (48.9%, chi 2 = 3.35, p = .067). Despite partial control of the system responsiveness variable, compliance with aftercare was suboptimal. This was due to a combination of client vulnerability variables and uncontrollable system responsiveness factors.

Predictors of initiation and engagement in substance abuse treatment among individuals with co-occurring serious mental illness and substance use disorders

“…Studies of psychiatric samples (i.e. samples of individuals who are identified in mental health settings and have some form of SMI) have found that comorbid substance abuse is one of the strongest factors associated with noninitiation and nonengagement in mental health treatment (El-Mallakh et al, 2004; Fischer et al, 2008; see Kreyenbuhl, Nossel, & Dixon, 2009 and O'Brien, Fahmy, & Singh, 2009 for reviews). Factors related to the context of treatment, including dissatisfaction with care and service providers, have been reported by individuals with SMI as reasons for nonengagement or disengagement in mental health treatment (see Kreyenbuhl, Nossel, & Dixon, 2009 and O'Brien, Fahmy, & Singh, 2009 for reviews).…”

Factors That Affect Treatment Initiation Among Individuals With Serious Mental Illness and Substance Abuse Disorder

“…It has been well documented that starting substance abuse treatment is particularly challenging among dual diagnosis patients (reviewed in Brown and colleagues 15,[28][29][30]. Prior studies have shown that dual diagnosis patients with psychotic spectrum disorders have an even greater challenge in successful treatment initiation.…”

After discharge from hospital, where do we go? Follow-up of clients with mental illness and/or addiction: 30 days post-acute care.

“…Increasing the percentage of follow-up after hospital discharge is a critical step to enhance treatment prognosis for people with mental illness and/or addictions (El-Mallakh et al, 2004;Byers & Cohen, 1979;Solomon, Davis, & Gordon 1984;Winston, Pardes, Papernick, & Breslin, 1977). A United States study revealed 50 % t to 60 % initial follow-up after hospital discharge with a range of 13% to 90% (ElMallakh et al, 2004).…”

“…They found that the variables or predictors related to follow-up compliance include client vulnerability, community support or system responsiveness (El-Mallakh et al, 2004). Of these three predictors, system responsiveness (convenience of scheduling and proximity of location) is cited more frequently than vulnerability of individual and community support as a barrier to follow-up (Klinkenberg & Calsyn, 1996).…”

“…Predictors for low follow-up correlate with diagnostic disorders, particularly when substance use is the primary diagnosis rather than secondary to the mental illness disorder (Allan, 1987). Individuals with little to no health insurance have the lowest rate of compliance for discharge follow-up services, whereas people who have psychiatric outpatient care prior to their hospital admission had higher proportions of follow-up (El-Mallakh et al, 2004). Daley and Zuckoff (1998) report that low levels of compliance are particularly noteworthy when following up with treatment for co-morbid conditions of mental illness and substance use (Booth, Cook, & Blow, 1992;Carey & Carey, 1990;Matas, Staley, & Griffin, 1992).…”