Should patients with chronic psychiatric disorders remain in hospital? Results from a service inquiry

The pattern of mental health care in Israel is undergoing major reform. In this report we explored hospitalization rates of 1,448 former long-stay psychiatric inpatients (70% of them with ICD-10 diagnosis of schizophrenia) subsequent to their transfer from countrywide psychiatric hospitals to 57 community-based hostels or alternative community settings between the years 1996-1999. Using data from the National Psychiatric Case Registry and a mirror image design, we examined the rates of readmission and calculated the number of saved hospital days during the community residence period, which compares more than two and four years, respectively, for 80% and 48% residents. T-tests, Mann-Whitney tests and analysis of variance were performed to examine differences in hospitalization rates and associated variables. Results showed that a minority, 36.2% of the former inpatients, was readmitted during their hostel residence. In comparison with an equivalent pre-hostel period, the time spent in hospital for those hostel residents that needed readmission was significantly shorter and the related day savings were considerably higher. The rehospitalized residents tended to be younger at their first hospitalization and at referral to the hostels, compared to those nonhospitalized. In addition, age by gender interaction, and length of hostel residence affected readmission rates. We may conclude that the policy decision to move the inpatients to a community setting is supported by the fact that the majority of the hostel residents was able to stay away from hospitalization.