Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

Abstract

Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3,601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for more than 20 years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36 % (n=697) were only administrative in their nature. Out of 2,197 truly discharged patients, 14.88 % (n=327) were re-hospitalized within two weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

“…The burden of mental and substance use disorders in CEE has been identified as one of the greatest in the world 13 , the prevalence of PTSD and other mental health problems seems to be considerably elevated in countries that have experienced recent conflict 14 , suicide rates are medium to high, 15 and the level of alcohol consumption is excessive. 16 Despite some success in deinstitutionalization and changes in legislation, 17 there is evidence of excessively long or unacceptably short hospitalizations 18 and otherwise inadequate services, 19 as well as reports of the abuse of psychiatry 20 and human rights violations in some countries 19,[21][22][23] . The allocation of financial resources for mental health care is reported to be far below the EU average of European Union (EU) 24 and the vast majority of resources are still spent on outdated institutional systems 25 .…”

Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis

“…Just like in other countries which have undergone the process of deinstitutionalisation, we do not believe that the results imply that there is no role for inpatient care but that shifting investments towards community care and providing timerestricted inpatient care is likely to give better value for money than long-term psychiatric hospitalisations. This argument adds to the human rights arguments based on the CRPD and especially on its article 19 emphasizing a right to live independently and in the community 4,38 , and clinical arguments based on long-term favourable outcomes of deinstitutionalized patients in other countries of the world 6,7 .…”

“…None of the studies included in this review, however, came from Central and Eastern Europe (CEE) where mental health care for people with severe mental illnesses is still predominantly provided in large psychiatric hospitals with limited community-based alternatives. In the Czech Republic, for example, people with schizophrenia are in many cases hospitalized for 5, 10 or even 20 years and there are currently more than 8000 psychiatric beds for adults 3,4 .…”

Trial of an intervention to reduce suicidal ideation and behaviour

“…The sexual competition hypothesis (SCH) for eating disorders 2 is an evolutionary formulation that can help answer the 'why' question that has so far defeated mainstream, non-evolutionary theories. It proposes that all eating disorders stem from the phenomenon of intrasexual competition taken to pathological extremes.…”