The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry

Abstract

International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.

Patterns of Mental Healthcare Provision in Urban Areas: A Comparative Analysis for Informing Local Policy

“…This suggests that acute inpatient care, despite being intended for the small number of people with severe illness (Department of Health, 2017), could be lling these gaps, both for people in crisis, and for those who are no longer acute but still require a level of subacute residential support, particularly in the Australian regions where it comprises a larger part of the overall system . Length of stay in fulltime hospitalisation has been shown to correlate negatively with the development of alternatives to fulltime hospitalisation in the local context (Gandré et al, 2017). The lack of day care services in the Australian regions may also increase the need for inpatient care, as availability of day care services may play a role in reducing hospitalisation, maintaining health and promoting community participation through (i) the provision of alternatives to hospitalisation in the case of acute health related day services; and (ii) through assistance with skills training and education in the case of work related and structured day services.…”

Potential Hospital Care Accessibility Scores: Association with Healthcare Utilization and Non-Hospital Care Service Accessibility

“…France, a study used the LOS for public-sector psychiatric facilities to investigate whether the development of alternatives to full-time hospitalization (such as ambulatory care, part-time hospitalization, and full-time outpatient care) may reduce the LOS [15]. They found a significant negative association and concluded that their study was the first to provide nation-wide evidence of the benefits of alternatives to full-time hospitalization in psychiatry.…”

“…Indeed, in many countries, the healthcare system is based on a combined architecture: non-hospital care based on general practitioners who can address patients to other healthcare professionals (e.g. nurses, physiotherapists, specialists doctors) and hospital-based care [14,15]. Non-hospital care represents the most significant primary care contributor in many countries, including developing countries [16,17], because it ensures an effective and generally faster service that covers the large majority of personal healthcare needs [18], and acts as the principal point of continuing care for patients [19].…”

“…Traditionally, healthcare utilization has often been expressed in terms of health outcomes and healthcare service volume. For instance, one classical indicator is the length of hospital stays that can be interpreted as an indicator of healthcare supply and treatment efficiency [15,[27][28][29]. Thus, it can be recognized as an indicator of the quantity and quality of the healthcare delivered by the healthcare system.…”

Length of Stay of Psychiatric Admissions: a Case-Control Study

“…Psychiatric hospitalisation is often long-term and justifiable based on the risks to oneself or others combined with a severe incapacity to provide proper self-care that is exacerbated by the absence or insufficiency of family and/or social support. Mental disorders that may require prolonged psychiatric hospitalisation include schizophrenia [11,12] and major depressive disorder (MDD) [13] because of the risks they pose to affected patients and others. The time interval between the onset of the disorder (often unclear) and the initiation of appropriate treatment can be very long.…”