Serving the chronic mentally ill in state and community hospitals

Abstract

Acute psychiatric admissions to three state and three community hospitals from the same geographic areas were examined in terms of patient characteristics, services, and costs. Overall, patients in state hospitals were more likely than patients in community hospitals to be admitted involuntarily, to have bizarre or assaultive behaviors as a precipitating cause of admission, to have recent community mental health involvement, to be referred by family or friends, to be living in dependent care at admission, and to have police initiated admissions; differences on other variables such as prior psychiatric hospitalizations, or in-hospital behaviors were not significant. The length of stay was longer for state hospital patients who were also more likely to be discharged to an independent living situation. While actual costs per inpatient day were greater for community hospitals, the costs of treating patients in state hospitals, after reimbursements, were greater on both an inpatient day and episode basis. The average savings per inpatient day of treating all patients in community hospitals versus the hospitals they were in at the time of the study would be $7.38 per day. The conservative average cost savings per episode would be $440. This data suggests that it may be less expensive to the state to treat patients in community hospitals.

The Measurement of Improvement During Hospitalisation for Acute Psychiatric Illness

“…Systematic differences in either overall severity or in length of stay, or both, according to legal status, could go some way to accounting for the public-private differences observed. It is reasonable to expect that involuntary patients will have more severe problems than their voluntary counterparts [14]. Unpublished data from the Victorian field trial of the HoNOS in the public sector showed that the mean total score (computed on just the 11 items common to HoNOS versions 3 and 4) was 13.2 for 64 voluntary inpatients and 14.6 for 172 involuntary inpatients.…”

O doente mental crônico internado: uma revisão da literatura

“…Em uma pesquisa (6) comparando as características de indivíduos internados em hospitais psiquiátricos tradicionais com os de instituições comunitárias (hospitais gerais, hospitais dia), foi concluído que não havia diferenças significativas entre estes grupos no que se refere a internações anteriores e comportamento dentro da instituição. No entanto, os admitidos nos hospitais tradicionais o eram, mais freqüentemente que o outro grupo, de forma involuntária; tinham indicações para serem internados que variavam de pressões familiares, de amigos, ou mesmo policial, por comportamento bizarro ou ameaçador; e viviam sob a dependência de cuidados básicos dos outros (família, sociedade).…”