Psychiatric hospital admission

In a previous column I talked about some of the reasons why a person might be admitted to a psychiatric ward in the hospital. Often, this occurs when individuals are a danger to themselves or others or when they are unable to function on their own.

In these cases, hospital admission is often necessary and is a way to protect mentally ill individuals while stabilizing their condition so that they can cope on their own once again.

However, our current system leaves much room for improvement in the area of psychiatric hospital admission and patient follow up.

Currently, more than a third of all patients hospitalized for mental illness are re-admitted within one year. This is 10 percent higher than the readmission rate for all other patients and points to a problem in the way psychiatric patients are followed after an initial hospital admission.

Mood disorders such as depression and bipolar disorder account for the majority of hospital admissions – 45 percent – as well as schizophrenia and psychotic disorder which come in a close second at 41 percent of admissions. One in five patients hospitalized for mental illness also has a co-existing substance use disorder such as alcoholism.

Changes in funding and mental illness management have translated into a steady decline in the length of hospital stays over the past decade. Patients should no longer expect to remain in hospital until they are well, but only until they are stable enough to cope again in the community.

Obviously, this ability to cope depends on the individual as well as on the support structures available to him or her. Family support, community resources and adequate psychiatric follow up are all important.

Unfortunately, many patients are discharged from the hospital with inadequate follow up plans and there are insufficient resources for crisis intervention when problems develop. All too often, post-discharge problems are dealt with by re-admission to hospital because there is no one available to see the patient in a timely fashion.

Not only is this unfortunate, but it is an unnecessary use of hospital resources since in many cases all that is needed is an adjustment of medication, some supportive counseling or financial assistance. All of this could reasonably be provided in a setting outside of the hospital.

In spite of rhetoric to the contrary, governments have been slow to provide appropriate community alternatives to hospital care. Access to nurses, doctors and social workers is needed by most patients after a hospital discharge.

Ideally, these professionals would cooperate to provide solutions and support for problems encountered after release from the hospital.

After hours assistance is also needed for patients experiencing mental illness. Currently, it is very difficult to receive help in a crisis if that crisis occurs during the evening or on the weekends – and hospital admission becomes the default solution when nothing else is available.

Some forward-thinking organizations have provided crisis intervention units that allow for all of these resources without hospital admission. Some of these places even offer the ability to keep someone overnight during a crisis if necessary without formal admission. In most cases, patients who use such facilities prefer them to being re-admitted to hospital.

Certainly, this kind of resource is much more cost effective than hospital admission and also better serves the interests of the patient.

 

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