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Does mental health service integration affect compulsory admissions?

Wierdsma AI, Mulder CL - Int J Integr Care (2009)

Bottom Line: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration.Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district.However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.

View Article: PubMed Central - PubMed

Affiliation: University Medical Center Rotterdam, Department of Psychiatry, O3 - Mental Health Care Research Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.

ABSTRACT

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services.

Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up.

Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district.

Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.

No MeSH data available.


Emergency compulsory admissions per 10,000 inhabitants by neighborhoods in Rotterdam (2000).
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fg001: Emergency compulsory admissions per 10,000 inhabitants by neighborhoods in Rotterdam (2000).

Mentions: In this study, we linked data from the medical reports with the psychiatric case register for the Rotterdam region, which since 1990 has covered all contacts of the local inpatient and outpatient mental health services with inhabitants in the catchment area [21]. For 1991–1993 and 2001–2003, we selected all first compulsory admissions to one of the region’s psychiatric hospitals of patients aged 18–60 years, living in Rotterdam. Patients’ records were matched by means of computerized record linkage [22], using a limited number of identifiers; 146 patients were excluded because of missing data (total n=830). Ethics approval was secured from a review board that represents all institutions participating in the case register. Figure 1 illustrates the northern and southern districts and rates of compulsory admission at neighborhood level. The map shows higher rates in the older, inner-city neighborhoods and similar variations in both districts.


Does mental health service integration affect compulsory admissions?

Wierdsma AI, Mulder CL - Int J Integr Care (2009)

Emergency compulsory admissions per 10,000 inhabitants by neighborhoods in Rotterdam (2000).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2748183&req=5

fg001: Emergency compulsory admissions per 10,000 inhabitants by neighborhoods in Rotterdam (2000).
Mentions: In this study, we linked data from the medical reports with the psychiatric case register for the Rotterdam region, which since 1990 has covered all contacts of the local inpatient and outpatient mental health services with inhabitants in the catchment area [21]. For 1991–1993 and 2001–2003, we selected all first compulsory admissions to one of the region’s psychiatric hospitals of patients aged 18–60 years, living in Rotterdam. Patients’ records were matched by means of computerized record linkage [22], using a limited number of identifiers; 146 patients were excluded because of missing data (total n=830). Ethics approval was secured from a review board that represents all institutions participating in the case register. Figure 1 illustrates the northern and southern districts and rates of compulsory admission at neighborhood level. The map shows higher rates in the older, inner-city neighborhoods and similar variations in both districts.

Bottom Line: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration.Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district.However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.

View Article: PubMed Central - PubMed

Affiliation: University Medical Center Rotterdam, Department of Psychiatry, O3 - Mental Health Care Research Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.

ABSTRACT

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services.

Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up.

Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district.

Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.

No MeSH data available.