Repeated psychiatric hospitalizations, affecting primarily those individuals with a serious mental illness, are a substantial problem. Little is known about the effectiveness of different lengths of hospital stay for these patients, transition support services after discharge, short-term alternatives to psychiatric rehospitalization, or long-term approaches for reducing psychiatric rehospitalization.
To describe and compare four core management strategies to reduce psychiatric readmissions--length of stay for inpatient care, transition support services (i.e., care provided as the individual moves to outpatient care), short-term alternatives to psychiatric rehospitalization (i.e., short-term outpatient care provided in place of psychiatric rehospitalization for those not at significant risk of harm to self or others), and long-term approaches for reducing psychiatric rehospitalization--for patients at high risk of psychiatric readmission.
We searched published and unpublished sources for information about the effectiveness of these strategies. We also interviewed Key Informants, representing mental health providers, health services researchers, policymakers, payers, and patient advocacy groups, to confirm and augment our findings.
Other than Assertive Community Treatment (ACT), a long-term approach for reducing psychiatric rehospitalization, we did not identify an overall theoretical model that identified key intervention components. Components of the various strategies overlap and are likely interdependent. Evidence suggests that the most commonly measured outcome, psychiatric readmissions, probably undercounts true readmission rates; other measures of well-being and functioning need to be measured. Of the 64 studies that assessed the link between a management strategy and readmission, 2 addressed LOS, 5 addressed transition support services, 4 addressed short-term alternatives to psychiatric rehospitalization, and 53 addressed long-term approaches for reducing psychiatric rehospitalization. The bulk of these studies address three interventions: case management, involuntary outpatient commitment/compulsory treatment orders, and ACT. The availability and implementation of the various management strategies can vary substantially across the country.
Important next steps include determining (1) the key components, or packages of components, that are most effective in keeping those at high risk of psychiatric rehospitalization functioning in the community; (2) how to accurately measure the most meaningful outcomes; and (3) how to most efficiently apply effective strategies to areas with varying resources.