Reluctance to readmit psychiatric patients

Psychiatric patients whom staff on an inpatient service were reluctant to readmit were compared to all other patients about whom no such reservations had been expressed. The former group revealed a much greater number of readmissions and a greater proportion of males. Although no statistically significant differences in diagnoses were found, there tended to be a greater proportion of patients with personality and affective disorders and a lesser proportion of those with neurotic and other disorders in this group. There was agreement among clinicians that patients with antisocial and aggressive personalities were difficult to treat, resulting in staff reluctance to readmit them. Marked disagreement about readmitting other patients who did not respond well to treatment efforts indicated differing tolerance among clinicians and also different attitudes toward, and philosophies of, treatment of difficult chronic patients. These data raise further questions concerning factors contributing to chronicity and poor prognosis in psychiatric patients. Recent work indicates that consideration should be given not only to individual characteristics of patients but also to the contribution of the characteristics and attitudes of their families, mental health professionals, and programs in the maintenance of chronicity.