Regional differences in the use of psychiatric hospital beds in Finland: a national case-register study

We investigated the possible differences in the utilization of psychiatric hospital beds among five social security areas in Finland, and the association between the variables related to the psychiatric services and the use of hospital beds. The use of hospital beds varied quite distinctly among these areas, as did the total rate of in-patients, readmissions, and rates of in-patients with psychotic and affective disorders. The treatment practices appeared to vary as the length of stay (LOS) and the rate of committal differed regionally in a significant manner. There was a significant positive correlation between the total rate of in-patients and the rate of readmitted patients (r=0.92, P<0.001), and a significant negative correlation between the number of visits per worker in out-patient care and the rate of readmissions (r=-0.94, P <0.001).     

Prism: The psychiatric rehabilitation integrated service model—A public psychiatric hospital model for the 1990s

The Massachusetts Department of Mental Health's Metro South Area developed an inpatient psychosocial rehabilitation model called PRISM (The Psychiatric Rehabilitation Integrated Service Model) which emphasizes skill development and patient participation. This article describes the transformation of a state hospital into a rehabilitation treatment facility using the PRISM model. This approach has the potential to improve quality of life, decrease relapse, and increase the efficiency and responsiveness to patient needs of public sector hospitals.     

Involuntary psychiatric hospital treatment among 12- to 17-year-olds in Finland: A nationwide register study

Information on involuntary psychiatric hospital treatment of all 12- to 17-year-old minors in 1990 and 1993 in Finland was collected from the national hospital discharge register. Involuntary treatment was associated with older age, psychosis diagnosis, and treatment in adult psychiatric ward. Treatment year, sex, and having previous psychiatric hospital treatment were not associated with involuntary treatment. Considerable differences were found when different health care districts were compared. In 12 of 22 districts there were no minors in involuntary treatment in 1993. For ethical and legal reasons the involuntary treatment of minors in adult settings can hardly be justified.     

Psychiatric hospital care among children and adolescents in Finland: a nationwide register study

This register study includes all patients under 18 years in Finland discharged from psychiatric inpatient treatment in 1990 (n = 818) and 1993 (n = 958). The prevalence of children and adolescents in the population who had previously been treated was about 7–8 per 10,000. The incidence of new cases of children and adolescents who had previously been inpatients within the last year was about 5–6 per 10,000 in this age group. The prevalence was lowest in the preschool group (about 1:10,000) and highest in the adolescent group (about 12–14:10,000). About two-thirds of inpatients were boys. Adjustment disorders (DSM-III-R) were the most common diagnosis both in 1990 and 1993 (about 30%). Mood and anxiety disorders were the second most frequent (19–23%) and disruptive behaviour disorders the third most frequent (13–15%) diagnostic category. The diagnostic profiles differed largely according to sex and age. Accepted: 18 May 1998     

Long-term medium-security hospital units: a service gap of the 1990s?

The majority of psychiatric patients, even those who also offend against the law, are likely to be served best by good community services but a few of them will need treatment in a secure hospital. Treatment in high security for patients from England and Wales is provided by three special hospitals. In the 1980s provision of medium-secure hospital units began, but there is still a considerable shortfall of such beds. Data from a variety of settings suggest that the continuing gap in medium-secure provision may be qualitative as well as quantitative. This paper considers the case for long-term medium security, and the likely size and nature of demand. It would be misleading to assume that those with long-term medium-security needs constitute a homogeneous group. Some new facilities, probably built on to existing medium secure hospital units, are likely to be needed; if estimates of real need for high-security places are correct, then some places already exist and are being used by default in the special hospitals. For some patients, notwithstanding the old image of special hospitals, these may be ideal placements if redesignated, even redesigned. A variety of provision and effective cooperation between purchasers and providers will be essential to satisfy real need and ensure that the number of patients needing secure accommodation remains more or less within present estimates. Copyright © 1996 Whurr Publishers Ltd.     

A national study of psychiatric hospital care

BACKGROUND: The delivery system for psychiatric inpatient services in the United States has changed dramatically over the past 30 years, undergoing a marked privatization. METHOD: To assess the effect of changes in ownership and types of inpatient settings on the structure of the mental health services system, the authors surveyed a national sample of nonfederal mental health facilities in 1988. RESULTS: Comparing their data to those of earlier surveys, they found that a decline in the number of patients per staff occurred in most settings over the last decade, suggesting that this aspect of quality of care may have improved. They observed important ownership-related differences in 1988 in diagnostic mix (e.g., more schizophrenia treated in public facilities than in private ones) and in payer source (e.g., more third-party revenues in public facilities than occurred in the past). CONCLUSIONS: There was a significant interaction between ownership form and type of facility, suggesting that the type of inpatient setting, ownership, and the relation between the two should be considered in assessing the impact of privatization on the accessibility of health care available for the mentally ill. The authors found that the increase in private psychiatric hospitals has widened the availability and choice of treatment facilities for those with private funding sources (especially children and adolescents) but has not had a similar effect in increasing sources of care for the seriously mentally ill dependent upon public financing.     

Self-poisoning with medications in adolescents: a national register study of hospital admissions and readmissions

ObjectiveTo examine characteristics of hospital admissions and risk factors associated with rehospitalization for self-poisoning with medications in adolescents aged 10–19 years.MethodThis study used data from the Norwegian Patient Register from 2008 to 2011. The main outcome was hospital readmission within the observation period. A complementary log–log regression model was used to assess the effect of characteristics at index hospital admission on readmission.ResultsOf 1497 patients, 76.4% were females and 89.8% were aged 15–19 years. At their first hospital admission, about one third received a secondary psychiatric diagnosis. Females (47.5%) were registered with an E-code for intentional self-harm more often than males (33.7%), and females were more often than males discharged to further treatment (27.8% vs. 21.5%). As many as 18.4% were rehospitalized for self-poisoning by medications. Significant predictors for hospital readmission were female sex [hazard ratio (HR)=2.4, 95% confidence interval (CI) 1.7–3.6], discharge to further treatment (HR=2.3, 95% CI 1.8–2.9) and psychiatric secondary diagnoses (HR=1.5, 95% CI 1.2–1.9).ConclusionThis national study demonstrated significant sex differences in adolescents treated in hospital for self-poisoning with medications. Psychiatric secondary diagnoses had a strong predictive effect on readmission, which indicates the importance of psychiatric/psychosocial assessment of adolescents who are admitted to hospital for self-poisoning with medications.     

Trends in discharge disposition,mortality, and service use among long-stay psychiatric patients in the 1990s

OBJECTIVE: This study examined changes in discharge disposition, mortality, and service use among three cohorts of highly vulnerable long-stay psychiatric patients in the Department of Veterans Affairs (VA) mental health system during the 1990s, a period of extensive bed closures. METHODS: National VA administrative databases were used to identify and prospectively follow three long-stay cohorts: mental health inpatients who had been hospitalized for at least one year as of the end of fiscal year 1991 (N=2,343), 1994 (N=1,853), and 1997 (N=1,156). The cohorts were compared in baseline demographic and diagnostic characteristics as well as discharge disposition, mortality, and service use over a three-year follow-up period. RESULTS: Nationally, the number of occupied long-stay beds decreased by 50 percent between 1991 and 1997. Over time, significant changes were noted in long-stay patients' principal diagnoses and discharge dispositions. Compared with the 1991 cohort, the 1994 and 1997 cohorts had a higher proportion of patients with psychotic disorders (69 percent, 77 percent, and 75 percent, respectively) and were more likely to be discharged from the hospital during the three-year follow-up period (33 percent, 54 percent, and 53 percent, respectively). However, among patients who were discharged, no substantial differences were noted in either mortality or overall VA service use across the three cohorts. CONCLUSIONS: The delivery of inpatient VA mental health services changed dramatically during the 1990s. This study provided evidence that continuing efforts to close VA mental health beds have not resulted in substantially adverse changes in mortality rates or in the extent to which long-term inpatients remain connected with the VA system after discharge.     

A study of the inpatient service of a Nigerian psychiatric hospital

Psychiatric hospitals and psychiatric units of teaching hospitals are gradually replacing the “civil asylums” in prisons, for the care of mentally ill patients in Nigeria.According to Boroffka,¹ 15 of such asylums still exist in addition to eight psychiatric hospitals and four psychiatric units situated in teaching hospitals. The phasing out of these asylums is due partly to the availability of more effective treatment for mental disorders and increasing numbers of psychiatrists in the country.Apart from Anumonye² and Jegede and Adaranijo,³ who have described the pattern of psychiatric practice in a psychiatric unit of a teaching hospital with four beds, no comprehensive information exists on the types of psychiatric patients requiring admission, either for a long- or a short-term stay and the management pattern and the relationship of such management to the underlying psychiatric illness. The present study is a preliminary report of a long-term longitudinal study, which aims at investigating both of the above problems, using the inpatients of a large psychiatric hospital.     

The use of coercive measures in adolescent psychiatric inpatient treatment: a nation-wide register study

Purpose

To evaluate the extent and trends in the use of seclusion/restraint in psychiatric inpatient treatment of adolescents aged 12–17?years in Finland.

Methods

The National Hospital Discharge Register data comprising all psychiatric inpatient treatment periods of 12- to 17?year-olds in Finland during the period 1996–2003 was used. Time trends, regional variation and patient characteristics related to the risk of being subjected to seclusion/restraint in psychiatric inpatient treatment are reported.

Results

The average prevalence of use of seclusion and restraint was 1.71/10,000/year over the study period. Use of seclusion/restraint in adolescent psychiatric inpatient care first increased, peaking in 1999–2001, and then decreased. The decrease occurred after stricter legislative control of use of seclusion/restraint was introduced in 2002, despite that involuntary treatment periods did not decrease. Considerable regional variation was seen in the use of seclusion/restraint. A greater proportion of girls than boys were secluded/restrained. Seclusion/restraint was most common in schizophrenia, mood disorders and conduct disorder.

Conclusions

Legislative control had the desired immediate impact on the use of seclusion/restraint in adolescent psychiatric inpatient care. Legislative control is, however, not strong enough to ensure homogenous practices across the country, as there is many-fold regional variation in figures for using seclusion and restraint.     

The prognosis in early adulthood of child psychiatric patients: a case register study in Denmark

A register-based study of 485 children (0-15 years of age) admitted to a child psychiatric hospital from January 1, 1970 to December 31, 1972 who were followed up on December 31, 1986 showed higher rates of admission to psychiatric hospital in late adolescence or young adulthood (i.e. greater than or equal to 16 years of age) than found in an age-standardized general population. Patients with the childhood diagnosis neurosis (ICD-8 300 + 308.00) were found to have higher rates of admission with personality disorders (ICD-8 301.09-301.39 + 301.82-301.99) but not of other diagnoses including neurotic disorders. Patients with the childhood diagnosis of conduct disorder (ICD-8 301.09-301.99 + 308.01) had a higher risk of admission in adulthood with the diagnosis of personality disorders and drug or alcohol abuse. Girls with adjustment disorder (ICD-8 307 + 308.02-308.06) had higher risks of admission in young adulthood with diagnosis of personality disorders and psychosis. No connection was found between the age at first referral and the incidence of admission after the age of 15 years.     

Patterns of substance use among patients in an urban psychiatric emergency service

Data from patients visiting an urban psychiatric emergency service in California were examined to document incidence and patterns of substance use and ethnic differences among users. A total of 392 patients were randomly assigned to receive a drug screen (N = 198) or to receive usual care (N = 194). Forty-four percent of the mandatorily screened patients had positive screens for any substances: 37 percent were positive for any drugs, and 7 percent were positive for alcohol only. Cocaine was present in 62 percent of the drug-positive screens. Blacks were two and a half times more likely than whites to have positive screens for drugs and five times more likely to have positive screens for cocaine.