The Impact of Demographic, Clinical, and Institutional Factors on Psychiatric Inpatient Length-of-Stay

Navigating Through the Darkness: An Exploratory Study Unraveling the Experience of Hospitalization of Adolescents and Their Caregivers Amid Suicidal Presentations

Suicide prevention and treatment guidelines for pediatric patients often mirror adult strategies. Distinguishing itself from other pediatric specialties, when a child is psychiatrically hospitalized, the child is typically separated from their family, despite the impact and possible ramifications of familial separation. This exploratory study explores the perceived impact of inpatient psychiatric treatment, through patient and caregiver narratives, aiming to enhance mental health treatment approaches. Focusing on the experience of 19 adolescent and parent dyads, we conducted thematic analysis of their interviews. Participants highlighted their hospital experience across two key categories: emergency department and hospitalization experience, including personal and social impacts of their stay. Findings are explored in the context of the helpfulness-harmfulness paradox and suggest that understanding these experiences from both adolescent and caregiver perspectives can inform improvements in psychiatric treatment practices. Despite limited research on optimal practices for acute psychiatric episodes, this study underscores the importance of considering the broader familial and emotional impacts of hospitalization.

Determinants of acute psychiatric inpatient length of stay in Ireland

BACKGROUND

Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services.

AIM

To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context.

METHODS

Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision.

RESULTS

The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5 days longer.

CONCLUSIONS

The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.

Commentary: Getting kids what they need, where they are, when they need it: home-based services in a continuum of care - a commentary on Boege et al. (2021)

In this edition of CAMH, Boege and colleague's 4-year follow-up study supports intensive home-based treatment as a viable alternative to inpatient hospitalization. Youth receiving home-based multimodal treatment fared just as well as those who remained hospitalized longer, with higher parental satisfaction. This study contributes to a sparse evidence base regarding longitudinal outcomes of psychiatric inpatient and intensive outpatient treatments for children and adolescents. Although mental illness is prevalent and increasing among youth, existing systems of care are often inadequate to provide flexible, effective, interdisciplinary team-based treatments, and supports for children and their families. Innovative approaches to providing evidence-based care and tracking outcomes are needed to strengthen the continuum of care.