Risk factors for repeated emergency compulsory psychiatric admissions

Abstract

Background The characteristics of patients who have repeated compulsory psychiatric admissions are largely unknown. Aims To investigate the frequency and risk factors for repeated emergency compulsory psychiatric admission (ECPA); and to identify targets for interventions to reduce repeated ECPA. Method Data were collected from a database of electronic patient files (EPFs) held by three psychiatric emergency services (PES) in the Netherlands. Analyses were based on the data for adult patients (aged 18–75 years) with a first PES contact in 2010–2015. Using descriptive statistics and regression analysis, we studied the associations between baseline patient factors and repeated ECPA and time to readmission, within a 2-year follow-up period. Results We included 6059 patients: 15.6% had two or more ECPAs. In total, 66% of second ECPAs had occurred within 6 months of the first. About 30% of all ECPAs were repeated ECPAs. Two baseline factors were associated with a higher frequency of a second ECPA: history of receiving any mental healthcare treatment, whether in-patient or out-patient or both, and a lower level of self-care. Three were associated with a lower frequency: ethnicity (other than Dutch), older age and suicidality. Lower Global Assessment of Functioning (GAF) scores and housing problems were associated with a shorter time to compulsory readmission and persistent psychiatric problems with a longer time to compulsory readmission. Conclusions We found that 15.6% of patients had two or more ECPAs. Two-thirds of the second ECPAs had occurred within 6 months of the first. Like earlier studies, the risk factors we identified suggest that interventions to reduce the risk of repeated compulsory psychiatric admission should seek to improve self-care, general daily functioning and homelessness.

Risk of psychiatric readmission in the homeless population: A 10-year follow-up study

“…This, added to the fact that shelters are not appropriate places to recover from an episode of mental illness requiring hospitalization ( Forchuk et al, 2006 ), generates a “perfect storm” that would explain the high rates of early psychiatric readmission found in this population. This is also supported by the fact that the lack of social support at discharge and the absence of availability of housing solutions are predictors of psychiatric readmission ( Scanlan et al, 2017 ; de Jong et al, 2021 ). So, many of these homeless users may experience the “revolving door” phenomenon, which indicates repeated hospitalizations of the same patients, and which has become a public health problem ( Doran et al, 2013 ; di Giovanni et al, 2020 ).…”

Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: “From Dusk Till Dawn”

“…Finally, we must acknowledge that the goal of most hospitalizations is not symptomatic remission or recovery; it is aimed to pave the way for further outpatient treatment ( 53 , 54 ). The readmission rates and time to readmission reflect the effects of an outpatient treatment capable of reducing the readmission rate and cumulative length of stay ( 55 , 56 ).…”

Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas

“…The phenomenon of frequent readmission, including readmission to hospital, is not new and has been described in the international mental health literature, 23,24 where a substantial proportion of people are reported to have multiple admissions. This highlights the need for effective interventions to prevent relapse following discharge into the community.…”