Identifying factors associated with the discharge of male State patients from Weskoppies Hospital

Abstract

BackgroundDesignated psychiatric facilities are responsible for the care, treatment and reintegration of State patients. The necessary long-term care places a considerable strain on health-care resources. Resource use should be optimised while managing the risks that patients pose to themselves and the community. Identifying unique factors associated with earlier discharge may decrease the length of stay. Factors associated with protracted inpatient care without discharge could identify patients who require early and urgent intervention.AimWe identify socio-economic, demographic, psychiatric and charge-related factors associated with the discharge of male State patients.MethodsWe reviewed the files of discharged and admitted forensic State patients at Weskoppies Psychiatric Hospital. Data were captured in an electronic recording sheet. The association between factors and the outcome measure (discharged vs. admitted) was determined using chi-squared tests and Fischer’s exact tests.ResultsDischarged State patients were associated with being a primary caregiver (p = 0.031) having good insight into illness (p = 0.025) or offence (p = 0.005) and having had multiple successful leaves of absences. A lack of substance abuse during admission (p = 0.027), an absence of a diagnosis of substance use disorder (p = 0.013) and the absence of verbal and physical aggression (p = 0.002 and p = 0.016) were associated with being discharged. Prolonged total length of stay (9–12 years, p = 0.031) and prolonged length of stay in open wards (6–9 years, p = 0.000) were associated with being discharged. A history of previous offences (p = 0.022), a diagnosis of substance use disorder (p = 0.023), recent substance abuse (p = 0.018) and a history of physical aggression since admission (p = 0.017) were associated with continued admission.ConclusionDischarge of State patients is associated with an absence of substance abuse, lack of aggression, multiple successful leave of absences and length of stay in hospital.

Prevalence and clinical correlates of substance use amongst acute psychiatric inpatients in Gauteng, South Africa

“…In South Africa, variable prevalence rates of SUD amongst psychiatric inpatients have been found. 10,14,29,30,31 Our results are similar to the 62% prevalence of a current SUD found amongst acute psychiatric patients in the Western Cape, 29 and to the 72% prevalence found amongst a sample of Gauteng state patients. 14 Using the ASSIST questionnaire in a study at a regional psychiatric hospital in KwaZulu-Natal, South Africa, 22 patients were reported to have a similar 54% recent alcohol use and 43% recent cannabis use.…”

“…9 Having a SUD increases the risk of violent behaviour in community and acute inpatient settings 10,11,12,13 and, in South Africa, it is associated with a longer duration of admission amongst male state patients. 14 Finally, suicidal behaviour, completed suicide and all-cause mortality are all increased in the presence of a comorbid SUD. 15,16,17,18,19,20 Background: Mental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes.…”

Challenges experienced by South African families caring for state patients on leave of absence

“…12 The findings are comparable with the emotion-focused coping mechanisms used by caregivers of people with mental illness, namely, tolerance, positive http://www.sajpsychiatry.org Open Access thinking and help seeking, whilst social support helped them to cope with the psychological distress. 7 Similar to research findings in the same study context, 21 families in this study indicated that the absence of high-risk behaviour such as substance abuse and aggression facilitates trust during leave that increases the likelihood of SPs being discharged.…”

State patients who committed violent crimes and were admitted to Weskoppies Hospital from 2005 to 2014: Profiles and trends

“… 4 , 7 , 8 The high rate of substance use has been a consistent finding in other South African studies and has been associated with longer admission periods and higher rates of recidivism. 13 , 23 …”