The Impact of Critical Time Intervention in Reducing Psychiatric Rehospitalization After Hospital Discharge

Abstract

Objectives This study examines the impact of Critical Time Intervention (CTI) in reducing re-hospitalization among formerly homeless individuals with severe mental illness following discharge from inpatient psychiatric treatment. Methods CTI is a nine-month care coordination intervention designed to support persons with severe mental illness in the transition from institutions to community living. Following discharge from inpatient psychiatric treatment, 150 previously homeless men and women were randomly assigned to receive either usual services only or CTI in addition to usual services. Study participants were assessed every six weeks for 18 months after entering the community. Results At the end of the follow-up period, psychiatric re-hospitalization was significantly lower for the group assigned to CTI compared with the usual services group (OR=.11, 95% CI=.01–.96). Conclusion This study demonstrates that CTI, primarily designed to prevent recurrent homelessness, also reduces the occurrence of re-hospitalization following discharge.

"I Want to Go Home, but I Need to Stay": The Transition to become Ready for Discharge from Acute Psychiatric Wards, as Narrated by Persons Who Experienced Acute Psychotic Illness

“…The participants expressed suffering and vulnerability related to physical and mental wounds and fragile or broken relationships with family members. Previous research has also highlighted the phase of time following acute psychotic illness as critical, demonstrating that the risk of new phases of psychosis increases during this time [4,9,16]. Furthermore, the risk of new phases of psychosis can decrease when nurses and persons in care plan the discharge and community care together to ensure the continuation of care at home [24][25][26].…”

“…[28,47]). Other authors have also reported that persons with severe mental illness express feeling unsafe and insecure before discharge about if the community mental health care can meet their care needs [9,[20][21][22]. Community mental health service that is provided by appointments primarily at daytime seems at this period of time after the acute psychotic illness not to be sufficient to the participants' needs of safety to manage their daily life at home.…”

“…From this perspective, the planning of the person's discharge from the acute psychiatric ward and his/her further mental health care in the community acknowledges and mirrors in national guidelines that recommend personal mental health care plans [6,7]. A person's discharge from an acute psychiatric ward to home is viewed as a transition [8,9], and the discharge plan is an important component of the transition between the different care settings [10].…”

“…Given that mental health care in acute psychiatric wards tends to be short term [1], the time available for the mental health nurses and the person in care to plan and prepare for discharge from acute psychiatric wards is limited [9,15]. Below, were view previous research papers on how persons in acute mental health inpatient psychiatric wards?…”

Integrating Hospital and Community Care for Homeless People with Unmet Mental Health Needs: Program Rationale, Study Protocol and Sample Description of a Brief Multidisciplinary Case Management Intervention

“…Randomized controlled trials (RCTs) have identified reductions among CTI participants, compared to usual care participants, in negative psychiatric symptoms (Herman et al 2000), alcohol and drug use problems, costs (Jones et al 2003) and psychiatric hospitalizations (Tomita & Herman 2012). …”