New long-stay patients in a psychiatric admission ward setting

Cowan, C.F.N.; Walker, Philippa

doi:10.1192/pb.29.12.452

Cited by 7 publications

(8 citation statements)

References 14 publications

(9 reference statements)

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“…This was less than figures obtained from previous studies i.e. 12% in a British study by Cowan and Walker (2005) 22 and 11% from a local study in Calabar, Nigeria. 6 However, this 10.7% bed occupancy by the long stay patients in our study remains quite high placing a heavy burden and pressure on the hospital facilities, especially with the current increasing number of acutely ill patients being brought to the centre on a daily basis that require hospitalization.…”

Section: Discussioncontrasting

confidence: 54%

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Long stay patients in a psychiatric hospital in Lagos, Nigeria

Taiwo¹,

Ladapo²,

Aina³

et al. 2008

Afr. J. Psych

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IntroductionIn psychiatric practice, some mentally ill patients spend their life in continuous or prolonged hospitalization; that is, as long stay patients. 1,2 This is due among other reasons to severe mental illness with poor symptom control, substance dependence, homelessness and abandonment by the patients' relatives. 3,4 Furthermore, in developing countries such as Nigeria, the situation is slightly different. The issue of long-stay patients is intertwined with the historical development of orthodox psychiatric care. In the early 20th century, asylums were established in selected towns and cities in the country by the then colonial powers. These were to serve as places of confinement or long-stay for psychiatrically ill offenders. 5,6 Over the years, these asylums were converted to fully-fledged psychiatric hospitals; with most of the long-stay offender inmates remaining in these facilities till date. 6 Another major source of long-stay patients is from the population of vagrant, psychotic individuals in the country. From time to time, the Nigerian print media focuses on this situation. 7,8 Some of these vagrant patients have over the years found their way to hospital, with a prolonged stay, by being brought to the centre by government health officials or most times by concerned members of the public. 9 Finally, in the study centre, the additional source of long-stay patients include some abandoned mentally ill returnee Nigerian soldiers from both the Second World War as well as the Nigerian civil war of 1967-1970. However, the cost of prolonged hospitalization care for these patients is borne by the hospital management. In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD -10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch's disease, HIV/AIDS. Despite being on hig...

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Section: Discussioncontrasting

confidence: 54%

“…17,22 The possible explanation in our study could be that male psychotic patients are more difficult to manage in the community hence increasing the likelihood of abandonment 14 and 43.1 years in the Calabar, Nigerian study. 6 The mean length of stay in the study was 11.4+15.0 years (range of 0.5-57 years).…”

Section: Discussionmentioning

confidence: 90%

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Taiwo¹,

Ladapo²,

Aina³

et al. 2008

Afr. J. Psych

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“…32,33 In such cases, collaboration between all relevant in-and outpatient services is crucial in facilitating the discharge process.…”

Section: 173031mentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions:Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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“…New long stay patients continue to accrue, despite the movement towards community based care [ 4 ]. A study by Cowan and Walker [ 28 ] found that a small number of long-stay admissions took up 12% of available admission ward capacity over 3 years, placing demands on the inpatient service greatly disproportionate to their numbers. Similarly it has been shown that many patients in acute admission units are inappropriately placed new long stay patients [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The virtual institution: cross-sectional length of stay in general adult and forensic psychiatry beds

Sharma

Dunn²,

O’Toole

et al. 2015

Int J Ment Health Syst

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BackgroundLength of stay in psychiatric hospitals interests health service planners, economists and clinicians. At a systems level it is preferable to study general adult and forensic psychiatric beds together since these are likely to be inter-dependent. We examined whether patients were placed according to specialist need or according to their cross-sectional length of stay.MethodsA one night census of all registered mental nursing home (RMNH) beds was carried out for a defined catchment area of 1.2 m population in north London in November 1999. This included all public sector psychiatric hospital beds, independent sector and forensic beds in and outside the catchment area. Cross-sectional length of stay was defined as time since the date of admission from the community. Log rank (Mantel-Cox) Chi squared was used to test for differences between groups and hierarchical logistic regression for statistical modelling.ResultsThere were 1,085 occupied psychiatric beds. Cross-sectional LOS was greater than 365 days in 43.5%. Forensic beds had longer cross-sectional LOS than general beds. LOS increased with the level of therapeutic security from open through low, medium and high secure. Cross-sectional LOS was shorter for open hospital beds than community RMNH beds, shorter for informal patients than those detained under civil mental health law, and longest for forensic detentions. Longest cross-sectional LOS were for patients placed in RMNHs in the community, 10.7% of whom were ‘forensic’ as were 25.4% of low secure patients. Designated length of stay (acute, rehab/medium term and long term) was also associated with increasing cross-sectional LOS. In regression analysis only three variables contributed to a model of cross-sectional LOS, commissioning status (general or forensic), designated length of stay and designated level of therapeutic security.ConclusionsStudying cross-sectional LOS for whole systems (all psychiatric beds) is essential for operational health service management. At the time of this survey ‘forensic’ status was the main way of accessing long term high dependency places. This has been an organic development over time, a response to patient needs rather than the outcome of any specific policy or plan.

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New long-stay patients in a psychiatric admission ward setting

Cited by 7 publications

References 14 publications

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

The virtual institution: cross-sectional length of stay in general adult and forensic psychiatry beds

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