Factors affecting the success of community placement: the TAPS project 26

Abstract

SynopsisLong-stay patients who were discharged from Friern and Claybury hospitals during the 6-year period between September 1985 and August 1991 were followed up for at least 1 year and the details of all readmissions were recorded. Of the 615 hospital leavers, some 178 (29%) were readmitted at some time during the follow-up period. A proportional hazards regression analysis revealed a number of independent baseline factors which affect the risk of readmission at any time during the follow-up period. Younger patients were more at risk of readmission than were older patients and ‘new’ long-stay patients had a greater risk than baseline patients. Risk was also greater in patients who had a larger number of pre-discharge admissions,a higher abnormal behaviour score (PSE BSO) or a diagnosis of manic psychosis. An ordinal logistic regression analysis revealed that these same five factors tended to increase the actual number of readmission episodes. The proportion of post-discharge time spent in hospital among the readmitted patients was found to be greater for males, new long-stay patients and for patients with a higher number of positive social behaviour symptoms (SBSPOS score).

Outcome of long stay psychiatric patients resettled in the community: prospective cohort study

“…The likelihood of readmission, as analysed for the first six cohorts, was greater for young men, those with more previous admissions, and new long stay patients 9. The last two cohorts, discharged from hospital from 1991 to 1993, had the highest proportion of new long stay patients and also the highest readmission rate.…”

“…Risk factors affecting readmission to hospital were inherent—that is, depended on age, sex, diagnosis, and previous admissions—rather than variabes related to care 9. This implies that even with the best treatment and adequate support, patients with schizophrenia or other chronic illnesses are prone to exacerbation of symptoms that necessitate periodic admissions.…”

The mental health residential care study: the “hidden costs” of provision

“…Across all settings and sectors, between 5 and 15% of the sample had an admission to psychiatric and general in-patient facilities over a 6-month period ( Table 2). This finding serves to highlight the fact that there remains a continuing in-patient requirement, and indeed corresponds to the requirement (for 100 former long-stay patients) of an average of nine or 10 in patients for short or long readmissions during the first year after discharge (Gooch & Leff 1996). For psychiatric wards, the duration of stay was typically about 1 month (ranging between a mean of 19 days for residents of group homes to 38 for residents of staffed care homes), whereas for general wards the mean duration of stay across the different facility types was between 6 and 13 days.…”

Can We Manage Without the Mental Hospital?

“…The TAPS follow‐up study found that 15% of them were readmitted at least once in the first year after discharge, and over one‐third during the 5‐year follow up. Gooch and Leff [20] calculated that to cope with this demand, 10 admission beds were needed for every 100 discharged long‐stay patients. This use of admission beds does not seem to have been taken into account in planning acute services.…”