Academic journal article The Israel Journal of Psychiatry and Related Sciences

Reduction in Inpatient Length of Stay and Changes in Mental Health Care in Israel over Four Decades: A National Case Register Study/Discussion

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Reduction in Inpatient Length of Stay and Changes in Mental Health Care in Israel over Four Decades: A National Case Register Study/Discussion

Article excerpt

Abstract: Background: The purpose of the present study was to investigate trends over the past 40 years in the accumulated length of hospital stay, and to consider how these trends might have been affected by changes in the provision of mental health care in Israel from 1960 to 1997. Methods: The national psychiatric case register was used to follow four cohorts of all new admissions in 1960, 1970, 1980 and 1990 diagnosed with schizophrenia or affective disorders for the first seven years following the index admission. Results: Most of the changes in length of stay occurred among patients with schizophrenia. The overall accumulated length of stay decreased by 50% between 1960 and 1980. The largest reduction was observed among long-stay patients with schizophrenia. Number of admissions did not change for the four cohorts. Limitations: The interpretation of the data remains speculative, as we are attempting to establish causality between parallel trends. Conclusions: The general trend in the findings of this study corresponds with changes that took place between 1970 and 1990 in the outpatient care for the mentally ill. These innovations facilitated the discharge of patients with chronic schizophrenia and altered the case mix of the newly admitted patients.

Introduction

Deinstitutionalization - the movement of psychiatric patients from the hospital into the community - has been occurring in the Western world for close to half a century. Israel has participated in this trend, as the number of hospital beds per general population has fallen while community services, attending to the medical, occupational, housing and rehabilitation needs of the psychiatrically disabled, have flourished.

The purpose of the present study was to investigate trends over the past 40 years in the time patients accumulated in psychiatric hospitals, and to consider how these trends might have been affected by changes in the provision of mental health care in Israel during this period, in particular the introduction of neuroleptic medications and the expansion of outpatient mental health clinics. Specifically, we examined patterns in accumulated length of hospital stay for first episode patients admitted in 1960, 1970, 1980 and 1990. We anticipated that changes in the infrastructure of services between the 1960s and the 1990s, in particular the shift in the provision of care from the hospital to the community, would be reflected in a gradual decrease in length of hospital stay and in number of hospitalizations.

Method

Data for the study were obtained from the national psychiatric case register (PCR) (1). The Ministry of Health has maintained this register since the early 1950s. All inpatient psychiatric facilities are required by law to report on every patient's admission and discharge. The registry includes basic demographic and psychiatric data for each individual. Diagnosis is recorded for each episode at admission and at discharge. The diagnosis is given according to diagnostic guidelines of the WHO. When ICD-10 was introduced in Israel, all the ICD-9 diagnoses in the register were reclassified according to the ICD-10 guidelines.

The inclusion criteria for this study were as follows:

* First admission occurred in the years 1960, 1970, 1980,or 1990.

* Diagnosis upon discharge was schizophrenia, schizoaffective, schizotypal and delusional disorders (F20-F29) or affective disorder (F30-F39).

* Born in Israel or immigrated there before the age of 20. New immigrants arriving at an older age were not included in the sample because of the greater uncertainty that the index hospitalization was indeed the first.

* Had their first hospitalization after the age of 21. Israelis admitted at ages 18-21 were likely serving their term of compulsory military duty. Anecdotal evidence suggests that patients admitted at this time are less likely to be diagnosed as suffering from schizophrenia even when the diagnosis is justified. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.