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Does mental health service integration affect compulsory admissions?
André I Wierdsma1, Cornelis L Mulder
1University Medical Center Rotterdam, Department of Psychiatry, O3 - Mental Health Care Research Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
International Journal of Integrated Care
|September 25, 2009
Summary
Increased compulsory mental health admissions may be reduced by integrated services. Integrated care showed shorter stays and better aftercare, though overall impact was limited.
Area of Science:
- Mental Health Services Research
- Public Health Policy
- Psychiatric Epidemiology
Background:
- Rising compulsory admissions linked to shift towards outpatient mental health care.
- Service integration may mitigate increasing involuntary psychiatric admissions.
Purpose of the Study:
- To compare compulsory admission rates and outcomes in integrated versus non-integrated mental health service districts.
- To assess the impact of service integration on patient care pathways and readmission rates.
Main Methods:
- Retrospective record linkage study comparing two districts with differing service integration levels.
- Analysis of patients (n=830) aged 18-60 with first emergency compulsory admission across 1991-1993 and 2001-2003.
- 12-month follow-up assessing psychiatric history and post-admission service utilization.
Main Results:
- Compulsory admission rates rose 47% over 10 years; integrated services showed a 14% lower relative increase.
- Integrated district had >10 days shorter length of stay and a greater decrease in involuntary readmissions.
- Aftercare was swifter and reached ~10% more patients in the integrated district.
Conclusions:
- Mental healthcare integration correlated with improved service outcomes, including reduced length of stay and readmissions.
- The overall effect of service integration on preventing compulsory admissions was limited.
- Other unexamined factors may play a more significant role in preventing compulsory psychiatric admissions.
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