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Winkler P, Mladá K, Krupchanka D, Agius M, Ray MK, Höschl C. Long-term hospitalizations for schizophrenia in the Czech Republic 1998-2012. Schizophr Res 2016; 175:180-185. [PMID: 27094718 DOI: 10.1016/j.schres.2016.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 04/01/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Abstract
Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for >20years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36% (n=697) were only administrative in their nature. Out of 2197 truly discharged patients, 14.88% (n=327) were re-hospitalized within 2weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, CI: 3.77-7.35, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.
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Affiliation(s)
- Petr Winkler
- National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Karolína Mladá
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Mark Agius
- Department of Psychiatry, Clare College, University of Cambridge, United Kingdom
| | - Manaan Kar Ray
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Cyril Höschl
- National Institute of Mental Health, Klecany, Czech Republic
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Winkler P, Barrett B, McCrone P, Csémy L, Janous̆ková M, Höschl C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry 2016; 208:421-8. [PMID: 27143007 DOI: 10.1192/bjp.bp.114.161943] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 10/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Reports linking the deinstitutionalisation of psychiatric care with homelessness and imprisonment have been published widely. AIMS To identify cohort studies that followed up or traced back long-term psychiatric hospital residents who had been discharged as a consequence of deinstitutionalisation. METHOD A broad search strategy was used and 9435 titles and abstracts were screened, 416 full articles reviewed and 171 articles from cohort studies of deinstitutionalised patients were examined in detail. RESULTS Twenty-three studies of unique populations assessed homelessness and imprisonment among patients discharged from long-term care. Homelessness and imprisonment occurred sporadically; in the majority of studies no single case of homelessness or imprisonment was reported. CONCLUSIONS Our results contradict the findings of ecological studies which indicated a strong correlation between the decreasing number of psychiatric beds and an increasing number of people with mental health problems who were homeless or in prison.
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Affiliation(s)
- Petr Winkler
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Barbara Barrett
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Paul McCrone
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Ladislav Csémy
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Miroslava Janous̆ková
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - Cyril Höschl
- Petr Winkler, PhD, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic, and Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Barbara Barrett, PhD, Paul McCrone, PhD, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK; Ladislav Csémy, PhD, Miroslava Janous̆ková, PhD, Cyril Höschl, DSc, FRCPsych, Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
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Pedersen PB, Kolstad A. De-institutionalisation and trans-institutionalisation - changing trends of inpatient care in Norwegian mental health institutions 1950-2007. Int J Ment Health Syst 2009; 3:28. [PMID: 20035623 PMCID: PMC3402049 DOI: 10.1186/1752-4458-3-28] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 12/25/2009] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Over the last decades mental health services in most industrialised countries have been characterised by de-institutionalisation and different kinds of redistribution of patients. This article will examine the historical trends in Norway over the period 1950-2007, identify the patterns of change in service settings and discuss why the mental health services have been dramatically transformed in less than sixty years. METHODS The presentation of the trends in the Norwegian mental health services and the outline of the major changes in the patterns of inpatient care over the period 1950-2007 is founded on five indicators: The average inpatient population, the number of discharges during a year, the average length of stay, the number of beds or places, and the occupancy rate (average inpatient population/beds). Data are reported by institutional setting. Multiple sources of data are used. In some cases it has been necessary to interpolate data due to missing data. RESULTS New categories of institutions were established and closed during the 57 years period. De-hospitalisation started in Norway in the early 1970s, de-institutionalisation in general 15 years later. Six distinct periods are identified: The asylum period (-1955), institutionalisation and trans-institutionalisation (1955-65), stabilisation and onset of de-hospitalisation (1965-75), de-hospitalisation (1975-87), from nursing homes to community-based services (1988-98), and the national mental health program (1999-2007). There has been a significant reduction in the number of beds and in the average in-patient population. The average length of stay in institutions has been continuously reduced since 1955. The number of patients actually treated in psychiatric institutions has increased significantly. Accessibility, quality of care and treatment for most patients has improved during the period. The mental health system in Norway has recently been evaluated as better than the systems in USA, England and Canada. CONCLUSIONS De-institutionalisation means fewer beds but not fewer patients treated, neither in institutions in general nor in psychiatric hospitals. The periods represent different kinds of de-, trans-, and even re-institutionalisation. Expansion of the welfare state, increased professional focus on active treatment and increased focus on patients' preferences are the factors that best explain de-institutionalisation in Norway.
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Affiliation(s)
| | - Arnulf Kolstad
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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Thompson CR, McKee M. Financing and planning of public and private not-for-profit hospitals in the European Union. Health Policy 2004; 67:281-91. [PMID: 15036816 DOI: 10.1016/j.healthpol.2003.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2003] [Accepted: 07/06/2003] [Indexed: 11/30/2022]
Abstract
While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.
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Affiliation(s)
- Ceri R Thompson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Honkonen T, Karlsson H, Koivisto AM, Stengård E, Salokangas RKR. Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland. Aust N Z J Psychiatry 2003; 37:160-8. [PMID: 12656955 DOI: 10.1046/j.1440-1614.2003.01137.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland. METHOD Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile. RESULTS In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved. CONCLUSION In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.
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Affiliation(s)
- Teija Honkonen
- Section of Clinical Neurosciences, Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, FIN-00250 Helsinki, Finland.
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