Literature Review Summary:

Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental illness
and those with addictions was more of a social stigmatizing act than a therapeutic act. After the
birth of the mental health disciplines, hospitalization associated with mental health issues
including but not limited to addictions was legitimized and has proven to be indispensable,
preventing further descent in quality of life and helping individuals in need. However, despite
more than a century passing since this legitimization occurred, ‘psychiatric hospitalization’ due
to mental health disorders and addictions, remains a controversial issue [1]. There is the
equivocal evidence of both possible negative and positive outcomes after a psychiatric admission
ceases to take its protective effect, and even of whether the psychiatric admission itself is related
to an improvement or a setback after discharge. It is also important to understand the efficacy of
discharge planning in mental health care. Authors have previously concluded that discharge
planning has been effective in reducing readmission to hospital and improving adherence to
aftercare for people with mental health disorders, therefore presenting better outcomes for mental
health and addiction patients. Backer et al. recognizes discharge planning as a process that
identifies and organizes services a person with mental illness, substance abuse, and other
vulnerabilities needs when leaving an institutional or custodial setting and returning to the
community [2].” The present review aims to summarize some of the most important outcomes
associated with hospital discharge from a psychiatric institution.

1
Outline of Existing Works for Mental Health/Addiction related studies
Y
e Refe
N for Imp
a Name Type Subjects renc Comments/Methods Results/Conclusion
studies act
r e

Variables studied - diagnosis, severity of

illness, symptomatology,
level of adaptive functioning, and social Multiaxial diagnostic approach that assesses
A support, locating aftercare resources and level of functioning, psychosocial stressors,
Review living arrangements psychosocial and presence of personality disorders together
of Issues 6 stresses, violent on self-destructive might be able to predict length of stay. One
Surround control behavior, Primary outcome-length of study reported that outcomes (rate of
1
ing led stay, and the paper focuses primarily on rehospitalization and role or work functioning)
9 Review
Length 1183 (Total) studie, [3]. studies delineating relationship between are better in long-stay patients with -ve
8 (Systematic)
of Uncont various patient and environmental schizophrenia and good prehospital
7
Psychiatr rolled? variables. With focus on length of stay, functioning. Another study reported that with
ic ? also enumerated comparison between the long stays up to 60 days worse health outcomes
Hospitali outcomes of long and short were documented in terms of role or work
zation hospitalizations. Secondary outcomes functioning. Rate of rehospitalization was
Rate of rehospitalization and higher in shorter stays (Mean 8 days).
Role or work functioning with length of
stay as predictor variable.
At six months after discharge 38% of the
patient had been readmitted to an institution,
most commonly a hospital. Dissatisfaction with
Psychiatr
The study reviewed the extent of finances independently exerted an influence on
ic
128 patients psychiatric rehospitalization following the the risk of readmission.
rehospita
1 consented to closure of large numbers of institutional Other factors were stability of accommodation,
lization
9 Primary/ participate in Austral psychiatric beds. It also examined the prescription drug, and nonprescription drug,
followin [4] -ve
9 Longitudinal the ia relationship between rehospitalization and found guilty of serious offences and or lesser
g
7 study. Follow the nature of psychiatric aftercare in a offences. There was no relationship between
hospital
up 6 months well-integrated hospital and community any history of psychiatric hospitalization (prior
discharg
based psychiatric service. to the admission at entry to the study) and
e
rehospitalization during the follow-up period.
Suicide was prominent: 3% of the cohort had
committed suicide at follow-up.
1 Violence Case- 1136 male and Study describes and characterizes the Median length of hospitalization for enrolled Neu
USA [5]*
9 by Control? female patients prevalence of community violence in a patients at the 3 sites was 9.0 days. Main tral/
1
9 People with mental sample of people discharged from acute finding: co-occurring substance abuse Nee
8 Discharg disorders psychiatric facilities at 3 sites. disorder to be a key factor in violence post ded
ed From between the Comparison group consisted of 519 discharge. The prevalence of community ?
Acute ages of 18 and people living in the neighborhoods in violence by people discharged from acute
Psychiatr 40 years which the patients resided after hospital psychiatric facilities varies considerably
ic discharge. according to diagnosis and, particularly, co-
Inpatient "Discharged mental patients" do not form occurring substance abuse diagnosis or
Facilities a homogeneous group in relation to symptoms. The patient sample exhibited
and by violence in the community. Study focused significantly higher rates of alcohol or drug
Others in on monitoring violence to others every 10 abuse symptoms than the community group
the Same weeks during their first year after during the first four 10-week follow-up periods
Neighbor discharge from the hospital. and in terms of violence and other aggressive
hoods acts there were significant main effects for
alcohol and drug abuse symptoms at each of
the follow-up periods. Significant differences
between the community and patient groups
(controlling for demographics, social
desirability, and MAST/DAST symptoms)
were found during the first and second 10-week
follow-up period for violence and for other
aggressive acts respectively.
The study found that deinstitutionalized
patients reported positive outcomes (i.e.,
Cost- A retrospective cohort of 96 pairs of
mental health and social relations, and cost-
effective psychiatric hospital patients with 1
effective) compared to those patients still
ness member deinstitutionalized between 1989
hospitalized. The study could not identify
2 analysis and 1998 was followed up for nearly 10
the elements associated with
0 of Canad years. Patients who were hospitalized for
Primary 192 [6] deinstitutionalization that were most likely +ve
0 psychiatr a more than one year at a psychiatric
responsible for positive results observed.
0 ic hospital. Patients were evaluated at the
The authors indicated that there is a need to
deinstitut start and end of the study on various
reorganize the mental health system with a
ionalizati clinical and social dimensions, as well as
view to ensure greater community
on. quality of life.
integration for people with severe and
persistent mental health disorders.

2
 19% met the criterion for noncompliance.
Patients who became medication noncompliant
The study sought to identify predictors of
received significantly poorer mean scores on
noncompliance with medication in a
four of the six Active Engagement Scale
Predictin cohort of patients with schizophrenia after
subscales. Medication noncompliance was
g discharge from acute hospitalization.
significantly associated with an increased risk
medicati Adult psychiatric inpatients with
of rehospitalization, emergency room visits,
on schizophrenia or schizoaffective disorder
homelessness, and symptom exacerbation.
noncomp for whom oral antipsychotics were
Compared with the compliant group, the
2 liance prescribed (N=213) were evaluated at
New noncompliant group was significantly more
0 after hospital discharge and three months later
Primary 213 York [7] likely to have a history of medication -ve
0 hospital to assess medication compliance. Eligible
City noncompliance, substance abuse or
0 discharg subjects were limited to English-
dependence, and difficulty recognizing their
e among speaking, newly admitted psychiatric
own symptoms. Patients with schizophrenia at
patients inpatients, between 18 - 64 years of age.
high risk for medication noncompliance after
with Comparisons were made between patients
acute hospitalization are characterized by a
schizoph who reported stopping their medications
history of medication noncompliance, recent
renia. for one week or longer and patients who
substance use, difficulty recognizing their own
reported more continuous medication use.
symptoms, a weak alliance with inpatient staff,
(1993-1996).
and family who refuse to become involved in
inpatient treatment.
Study examined whether patients Of the 542 patients who were rehospitalized,
discharged from inpatient psychiatric care 136 kept at least one outpatient appointment
Effects would have lower rehospitalization rates after discharge from their initial admission; 406
of if they kept an outpatient follow-up did not. For patients who did not keep an
Discharg appointment after discharge. Data was appointment, rehospitalization rates increased
e collected in 1998 on 3,113 psychiatric over time, ranging from 15 percent to 29
Planning admissions in 8 states; 542 were percent. For patients who kept an outpatient
and readmissions. Of the 542 patients who appointment, the rehospitalization rate
2
Complia Primary/Ret were rehospitalized, 136 kept at least one remained the same over time, about 10 percent.
0 Georgi
nce With rospective? 542 [8] outpatient appointment after the index The 270- and 365-day rehospitalization rates +ve
0 a
Outpatie hospitalization and 406 did not. and the aggregated annual rates were
0
nt Rehospitalization rates were calculated significantly higher (p>.01) for patients who
Appoint for 90, 180, 270, and 365 days after did not keep an appointment. Patients who did
ments on discharge to examine effects over time of not have an outpatient appointment after
Readmis keeping an initial appointment. The mean discharge were two times more likely to be
sion ± SD length of stay for the patients who rehospitalized in the same year than patients
Rates kept an appointment was greater than that who kept at least one outpatient appointment.
for those who did not (5.5±.4 days versus Aggregated annual rates indicated that patients
4.8±.6 days). who kept appointments had a one in ten chance

3
 of being rehospitalized, whereas those who did
not had a one in four chance.

37.0% of the men and 56.9% of the women

who committed suicide had a history of
admission to psychiatric hospitals. Crude risk
of suicide associated with this history was 14.1
Suicide
for men and 22.7 for women. For men and
Risk in
women, there were 2 sharp peaks of suicide
Relation
risk around psychiatric Hospitalization. The
to
The study explores suicide risk according risk was extremely high in the first week after
Psychiatr Suicides vs
2 to time since admission, diagnosis, length admission and particularly in the first week
ic Nested case- Matched
0 Denma of hospital treatment, and number of prior after discharge, then decreased gradually if
Hospitali control Controls-13 681 [9] -ve
0 rk hospitalizations. The outcome variable is admitted for a longer time or longer after
zation design. male and 7488
5 risk of suicide and adjusted for socio- discharge. Relative to schizophrenia spectrum
Evidence female suicides
economic factors. disorders, the risk exceeded slightly for
Based on
affective disorders in men and women; and for
Longitud
substance abuse disorders, in women.
inal
Moreover, risk for suicide was significantly
Registers
higher for patients with a shorter inpatient stay
in hospitals, and the risk increased with
increasing number of psychiatric
hospitalizations.
6.5% of the admissions were for self-harm in
the following 12 months. Risk of self-harm was
Hospital
greatest in the four weeks after discharge; one
admissio
Aim of the study was to determine the third (32%, n=1578) of admissions for self-
ns for All patients
risk of non-fatal self-harm in the 12 harm occurred in this period. The strongest risk
self- (n=75 401), 6-
months after discharge from psychiatric factor for self-harm after discharge was
harm 64 years who
inpatient care. Patients aged 16-64 years admission for self-harm in the previous 12
2 after had been
discharged from psychiatric inpatient care months (hazard ratio 4.9, 95% confidence
0 discharg discharged from Englan
Cohort study [10] between 1 April 2004 and 31 March 2005 interval 4.6 to 5.2). The risk of self-harm was
0 e from hospital after an d
and followed up for one year. Data also higher in females, younger people, those
8 psychiatr episode of care
documented from hospital episode with diagnoses of depression, personality
ic under a
statistics data for England which contain disorders, and substance misuse, and those with
inpatient psychiatric
records for all National Health Service short lengths of stay. Self-harm after discharge
care: specialist
patients admitted to NHS hospitals. from hospital shares many of the features of
cohort
suicide after discharge. Patients who self-
study
harmed tended to have shorter lengths of
hospital stay than those who did not self-harm
4
 across all diagnostic groups Interventions
should be developed to reduce risk in this
period.
The study found that there were no overall
differences between long-stay and short-stay
The aim of the present study was to
patients in terms of symptom severity or
assess the characteristics of long-stay
diagnostic status. Factors associated with long-
inpatients in public and private Italian
Long- term stays include display of violent behavior,
acute inpatient facilities, to identify risk
stay in lack of housing and shortage of community
factors and correlates of the long duration
short- 130 Italian support. The reasons given by treatment teams
of hospital stay in these patients, and to
stay public and to most likely factors contributing to the
identify possible barriers to alternative
inpatient private patients' prolonged hospital stays were lack of
2 placements; Methods used: standardized
facilities: psychiatric housing and community support were the most
0 assessment instruments to compare
risk Primary inpatients who Italy [11] frequently cited reasons preventing discharge. NA
0 patients discharged during the same index
factors had been Few patients reported financial difficulties
9 period. All inpatients with a length of stay
and hospitalized for (with the exception of lack of housing). 1/3rd
of more than 90 days and no planned
barriers more had no close relationships or social support,
discharge ("long-stay inpatients"), and all
to than 3 months and approximately four out of ten were at
inpatients staying for 90 days or less with
discharg rather high risk of antisocial behavior at
a planned discharge ("short-stay
e discharge. Correlates of long-stay status:
Inpatients"), in public and private
admission to a private facility, violent behavior,
facilities surveyed during an index period
poor personal and social functioning,
of 12 and 3 days, respectively.
unmarried status, older age, higher education
and receipt of rehabilitative intervention
Participants (n=36) were enrolled over a 7 Analysis of administrative data showed no
month period. They were interviewed at significant change in the number of discharges,
enrollment, at one month post-discharge or the average length of stay when the
and at 6 months post-discharge. discharge planning service was moved to the
An The variables of interest included the community. The change in the location of the
Evaluati degree of service received, satisfaction discharge planning service in the community
2 on of Port with service, quality of life, quality of coincided with a significant reduction in the
Report/
0 Commun Huron, activities, severity of symptoms, level of rate of readmissions occurring within one
Program 36 [12]
0 ity Based Michig functioning, and physical health. This month of discharge (p=0.026) and in the overall
Evaluation
9 Discharg an study evaluated an ‘in-reach’ model of readmission rate (p=0.022). Participants were
e discharge planning. In this model, the generally satisfied with their experience of
Planning discharge planner is based with the discharge and their involvement in the process.
community based services, and visits the The readmission rate in the first month after
hospital daily to meet with all admitted leaving hospital was 36% lower in the year
clients to offer discharge services. The following the move to community based
model is designed to provide seamless discharge planning. At one month, 67.7% of

5
 care to people leaving hospital after a
mental health admission. A program
evaluation strategy was used to evaluate
the effectiveness of this care model for
clients and for the agencies involved.
6 randomized controlled trials, 3
controlled clinical trials, and 2 cohort
studies (2838 allocated to the intervention
groups and 2817 to the control groups).
Reviews the effectiveness of discharge
Discharg planning in in-patient mental health care.
e Meta-analysis aimed at determining
planning whether discharge planning interventions
in mental can ensure continuity with post-discharge
2 Systematic cumulated
health out-patient care and whether they can
0 and meta- sample size of
care: a 11 [13] contribute to improving the course of
0 analysis 5655
systemati patient aftercare and outcome. Studies
9 Review participants
c review published between 1992 and May 2007
of the (last 15 years). Outcomes related to
recent support can last a limited period after
literature discharge. Outcome related to process of
patients care (e.g. readmission rate
connection to out-patient treatment,
length of stay and health outcome (e.g.
symptom reduction) along with costs
involved
The purpose of the study was to
The determine factors that contribute to HFU
revolvin of inpatient psychiatric services by
g door schizophrenia and schizo-affective
phenome disorder subjects in a developing country
2 non in with a view to understanding this
0 psychiatr South [14] phenomenon better. Data were collected
Primary 146 from 146 participants; 51 LFUs and 95
1 y: Africa * stabilizers (p < 0.01) and also to have been
0 comparin subjects meeting the HFU criteria. For
g ……..a HFU, one has to (a) ≥3 admissions in 18
developi months/≥5 in 36 months; (b) ≥2
ng admissions in 12 months AND treated
country. with clozapine; or (c) ≥2 admissions in
12 months AND ≥120 days in hospital .
the participants reported they were receiving
continued mental health care.
Studies were mainly conducted in North
America (USA and Canada), three came from
United Kingdom, and one each from Israel and
Japan. Discharge planning had significantly
lower readmission rates (RR 0.66); Discharge
planning had significantly higher adherence to
out-patient treatment or continuity of care (RR
1.25); Discharge planning produced significant
improvements in mental health outcomes +ve
(standardized scales/score) (Hedges' g -0.25).
Change in QOL and cost reduction (discharge
costs per participant), non-Significant.
Promoting implementation of discharge
interventions in mental health care for they can
contribute to reducing hospital stays and to
improving patients’ adherence to aftercare as
well as symptomatic impairment.
A consequence of deinstitutionalization has
been the phenomenon of the revolving door
patient; high-frequency users (HFUs) admitted
to hospital repeatedly, remaining well for only
short periods of time. HFUs had higher PANSS
scores were more likely to admit to lifetime
substance use (p = 0.01), be on mood
-ve
crisis (premature) discharges (p < 0.01). Crisis
discharge (p = 0.03) and depot use (p = 0.03) to
be the only remaining significant predictors of
HFU versus LFU status. High frequency users
characteristics to be similar across different
settings, with under-utilization of depot
6
 All subjects were clinically assessed
within 2 days of admission with the
Positive and Negative Syndrome Scale
for Schizophrenia (PANSS).
Mesh/ terms used - Clients, psychiatric
unit, mental health unit, acute, discharge,
discharge plan, discharge process, and
prevention of readmission. Inclusion
criteria were studies including outcomes
related to prevention of readmission as
stability in the community, studies
investigating the discharge planning
2 Psychiatr process in acute psychiatric wards
0 ic Review (assessment on admission, inpatient
NA - [15]
1 Discharg (Systematic) assessment, preparation of individualized
2 e Process discharge plan, provision of interventions,
monitoring), and studies that included
factors that impede discharge planning
and factors that aid timely discharge. On
the other hand, exclusion criteria were
studies in which discharge planning was
discussed as part of a multifaceted
intervention and was not the main focus
of the paper.
From 14 studies were identified to clarify the
hospital influence of deinstitutionalization (i.e.,
to the hospital to community-based settings) on
communi discharged long-stay patients. Four of the
2 ty: The seven studies that assessed patient quality
0 influence Review of life and attitudes. 2000–2012, with the
NA 14 [16]
1 of (Systematic) terms ‘long-stay’ or ‘chronic mentally ill’
3 deinstitut and ‘deinstitutionalis(z)ation’ or
ionalizati ‘community’ or ‘discharged’ in the title
on on and/or abstract. The present study defined
discharg long-stay as hospitalization >6 months.
ed The most frequently assessed outcomes
antipsychotics and early discharge from
hospital as particular contributors to high-
frequency use of services in our sample.
-Recommended a collaborative model to
inpatient staff who, until the wave of
deinstitutionalization overtook them, was more
accustomed to managing the acutely ill patient.
-focus on using a complete team- treatment
team should include psychologist, social
worker, psychiatrist, case manager, vocational
specialist, and housing professionals who
should participate in creating the discharge
plan. In addition, the team should include the
Neu
community partners of the client, such as peers,
tral
relatives, and friends.
-Application of discharge planning has
encountered with barriers.
-tailored for different needs of different client,
be comprehensive which mean address client’s
need across multiple health system in the plan,
create a system that is continuous and
coordinated, be practical and realistic, and
maximize available resources for the benefit of
the client.
Studies found that countries with
deinstitutionalization have overall or partially
positive results such as improvements in social
functioning, stability or improvements in
psychiatric symptoms, and improved attitudes
towards the environment. With respect to
+ve
rehabilitation, better results were
obtained in the studies that offered the
participants programs for or training in
everyday living skills. For QOL and attitude it
was found that patients were generally more
satisfied with their lives than those in more
7
 long-stay were social functioning, psychiatric restricted settings (e.g., psychiatric wards).
psychiatr symptoms and quality of life
ic (QOL)/participant attitudes towards the
patients. environment.

Aim was to evaluate the effect of short

stay/brief admission hospital care with
long stay/standard in-patient care in
people with serious mental illness. 6 low- No differences were found between the
quality?(as per McMaster mental health forum) groups in readmission to hospital, mental state,
(included all randomized controlled trials risk of death, and people lost to follow-up.
Length
comparing planned short/brief with There was a significant difference favoring
of
long/standard hospital stays for people short-stay hospitalization in terms of social
hospitali
with serious mental illnesses) studies functioning. The authors indicated that short-
2 zation
evaluated the effect of short stay hospital stay patients are more likely to leave the
0 for
Review N=1169 6 [17] care (less than 28 days) with long-stay hospital on their planned discharged date and +ve
1 people
patient care in people with serious mental possibly have a greater chance of finding
4 with
illness (1969-1980). employment. The review found that planned
severe
Intervention: Short stay (2-3 weeks): short-stay policies do not encourage a
mental
informed re short stay on admission, daily “revolving door” pattern of admission or
illness
psychiatrist visit (5 days), counselling disjointed care for people with
both recipient & family at discharge, and serious mental illness.
telephone access to psychiatrist thereafter.
N=100; Long stay: standard care.
N=1069. All participants had medication,
and outpatient care as required
Discharg At least half of these patients are rehospitalized
ed from or die by suicide in the long-term. Added to
a mental these two outcomes, violent behavior, social
health maladjustment, and stigma are other important
Current work focused on the negative
2 admissio negative setbacks after a psychiatric admission
outcomes after a psychiatric ward
0 n ward: Narrative ceases to exert its protective effect. All of these
- - [1] discharge, and found that there is a great -ve
1 is it safe Review outcomes seem to be more or less connected to
level of distress in this critical period
4 to go a problematic transition from the hospital,
home? A where patients are fully assisted in all of their
review daily life aspects, to the community, where
on the they must re-adapt to social roles and face the
negative obstacle of an inhospitable society.

8
 outcome
s of
psychiatr
ic
hospitali
zation
Objective was Assess the cost-
effectiveness of inpatient treatment versus
Hot-BITs-treatment (Home-treatment
brings inpatient-treatment outside), a new
Cost-
supported discharge service offering an
effective
early discharge followed by 12 weeks of
ness of
intensive support. Hot-BIT-treatment
intensive
included thorough assessment, early
home 164 patients
discharge, individualized home treatment The study reported that Hot-BITs-treatment
treatment admitted for
plans (i.e., case management, improved clinical function among patients and +ve
enhanced child and
psychoeducation and pharmacotherapy), is a cost-effective alternative to inpatient stays. (Alt
2 by adolescent
clinical elements (i.e. day hospital, Significant treatment effects were observed for ern
0 inpatient Randomized psychiatry who Germa [18]
supportive therapies), cooperation with both groups between T1/T2 and T1/T3 ativ
1 treatment Trial had an ny *
social services, biweekly review of (P<0.001). The Hot-BITs treatment, however, e
5 elements inpatient
treatment plans by the supervising was associated with significantly lower costs at rout
in child hospital stay for
psychiatrist, and crisis management. T2 and T3. Hot-BITs was less costly and e)
and greater than 72
Primary outcome was cost-effectiveness. tended to be more effective at T2 and T3.
adolesce hours
Effectiveness was gathered by therapist-
nt
ratings on the Children's Global
psychiatr
Assessment Scale (CGAS) at baseline
y in
(T1), treatment completion (T2) and an 8
Germany
month-follow-up (T3). Cost of service
use (health care costs and non-health care
costs) was calculated on an intention-to
treat basis at T2 and T3.
Associati Retrospective cross-sectional study 122 out of 449 patients (1/4th) received no
on included a questionnaire which collected support for coordination with post-discharge
449 patients
between information on patient characteristics, community care resources. A significantly
2 discharged from
length of Retrospectiv implementation of discharge planning, lower mean age at admission, a shorter length
0 the ‘psychiatric
hospital e cross- Japan [19] social functioning at discharge, and of stay, and a higher rate of either no follow-up -
1 emergency
stay and sectional length of stay. he assigned nurse or or unidentified post-discharge outpatient
5 ward’ of 66
impleme nursing assistant retrospectively rated service was reported. A significantly greater
hospitals
ntation implementation of the activity during the length of stay was documented among patients
of early-mid phase of the hospital stay and who were older, those who had a primary

9
discharg in preparation for discharge (1 =
e implemented, 0 = not implemented). The
planning early-mid phase was defined as the
in acute duration from admission to reduction in
psychiatr acute symptoms (e.g., the patient is
ic moved from a seclusion room to a shared
inpatient bedroom). Because the present study
s in focused on the link between inpatient
Japan treatment and community-based post-
discharge care, patients were divided into
the following two groups: 122 patients
who had received no support for seven
activities in coordination with post-
discharge community care resources both
during the early-mid phase and in
preparation for discharge, and the
remaining 327 patients who had received
any community care coordination
support.
diagnosis of schizophrenia, and those who were
admitted compulsorily, those who received
hospital outpatient services, and those who
received community care coordination support
from the assigned nurse or nursing assistant.
The implementation of support for community
care coordination did not indicate a significant
association with these factors, which have been
related to an increased risk of psychiatric
readmission. Implementation of discharge
planning demonstrated a negative association
with length of stay. A significantly longer
length of stay was observed among patients
who had received support on coordination with
post-discharge community care resources.
Author concludes - The mental health policy
should increase focus on discharge planning in
the acute psychiatric setting to enhance a link
between psychiatric inpatient care and post-
discharge community care resources.
10
 The participants ages ranged from 17 to 68
(median 45.5). Of the 18 participants, 17 lived
with family members, and one lived alone. The
This study utilized a qualitative
average number of times they had been
descriptive study design and incorporated
hospitalized in psychiatric hospitals was
Challeng patient interviews. Semi-structured
2.6(median 2.0) times. The mean length of
es interviews were used to elucidate
hospitalization at the psychiatric emergency
followin challenges from the patients’
ward during the latest hospitalization was 57.8
g perspectives. Participants comprised 18
days (median 57.0 days); mean length of time
discharg patients who experienced involuntary
spent at home after discharge was 142.2 days
e from admission following a diagnosis of
2 (range:65–244 days, median 135.6 days). The
acute Narrative schizophrenia spectrum disorder. At the
0 main challenge comprised two subcategories:
psychiatr Synthesis - 18 patients Japan [20] time of the study, between 1 and 6
1 ‘dissatisfaction with the inpatient care
ic in- Descriptive months had passed since their discharge
6 received’ and ‘lack of abilities to coordinate
patient from the hospital and they were receiving
lifestyle following discharge’. The results
care in outpatient treatment at the same hospital.
indicated that patients were unable to integrate
Japan: Inductive qualitative content analysis was
their experience of hospitalization with their
patients’ used to create codes and categories from
current life; this made them feel that the
perspecti interview transcripts. The core category
continuity of their lives had been disrupted.
ves of post-discharge challenges that emerged
This phenomenon comprises several elements,
was ‘separating life as an inpatient from
including dissatisfaction with the inpatient
community life’.
treatment. Negative acceptance of
hospitalization affects the increased
possibility of relapse.
Introduction of New Zealand Mental Health
Mental and Addiction Services Key Performance
health: Review looks at the planning for people’s Indicator Programme (KPI Programme
Effective discharge from an inpatient unit to Strategic Plan 2015-2020); and looked at the
ness of community, whether care was completed two indicators
2
the New as intended; if the needs identified by • follow-up contact with people after their
0 Report to
planning - Zealan [21] discharge planning were followed up after discharge from inpatient units; and #
1 Ministry
to d discharge; and if discharge planning was • people’s re-admission to inpatient units.
7
discharg helping to improve outcomes for people The target is for at least 90% of people to
e people with acute mental health problems. receive a follow-up contact but, on average,
from DHBs (district health board) manage to follow
hospital up with only two-thirds of people within seven
days.
*Some aspects of the study useful/ Different outcome/independent variable
# Result to be published

11
For Discharge planning for different outcomes-homelessness - Preventing Homelessness through Mental Health Discharge Planning
(http://homelesshub.ca/sites/default/files/Vol3_LiteratureReview.pdf);
Also read: Evaluating the effect of short-stay hospital care with long-stay patient care among people with mental health issues (McMaster Health Forum);
https://www.mcmasterforum.org/docs/default-source/product-documents/rapid-responses/addressing-long-term-stays-in-hospital-for-people-with-mental-health-
and-addictions-concerns.pdf?sfvrsn=2

12
Conclusions
Data from high-income countries including the UK, USA and Canada report that up to 13% of
psychiatric patients are readmitted shortly after discharge from acute psychiatric units. Early
readmission, usually defined as within 90 days of discharge, represents a negative clinical
outcome for patients. Given the high cost of emergency department visits and in-patient
psychiatric treatment, it is an important economic issue for policy-makers as well. As such, early
psychiatric readmission has been adopted as a negative quality of care indicator internationally
and governments are now setting benchmarks for reducing early readmission. In targeting this
problem, a key issue that has been explored is that early psychiatric readmission may reflect not
only the quality of in-patient care, but also the degree of continuity of care with services
provided in other parts of the mental health system. In particular, it may reflect the ability of
mental health systems to provide coordinated care and support as patient’s transition from
hospital to less intensive types of ambulatory care. Surprisingly, however, evidence in support of
interventions designed to optimize this transition is limited, and not much attention has been paid
to optimize the length of stay for most effective outcomes. Reports about quality improvement
initiatives exist; but a systematic review evaluating the role of hospital discharge timing,
associated interventions and its impact on reducing psychiatric readmission identified only for a
few studies in the literature. Recent studies on discharge planning reveal that they have capacity
to smoothen the transition from in-patient to out-patient care by coordinating fragmented
services, and thus to improve patient outcome and medication adherence, prevent
rehospitalization and save costs [13]. These studies can be summarized simply by presenting a
good planning, before a person is discharged from hospital to community support services. This
is critical in effectively supporting people with mental health problems. Discharge planning
identifies and organizes services a person with mental illness, substance abuse, and other
vulnerabilities needs when leaving an institutional or custodial setting and returning to the
community. When done well, “discharge planning” brings together a person’s health and broader
social needs and enables those needs to be met. It is a process that aims to improve the
coordination of services after discharge from hospital by considering the patient's needs in the
community and reviews and seeks to bridge the gap between hospital and the place to which the
patient is discharged, reduce length of stay in hospital, and minimize unplanned readmission to
hospital [22]. As part of a spectrum of health care and social services, discharge and transition
planning can play a significant role in preventing homelessness (Backer et al., 2007). The focus
can also be on developing discharge planning interventions tailored to the care needs in different
diagnostic subgroups.

1
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