Table 1 Literature investigating factors associated with admission to psychiatric hospital in the context of an alternative to hospital
Paper and country of origin | Comparison groups and statistical analysis | Description of the service alternative to hospital admission | Variables found to be significantly associated with psychiatric hospital admission |
|---|---|---|---|
Brimblecombe N 1999 [17] Brimblecombe N 2003 [19] UK | 197 subjects in HT compared to 121 admitted to hospital Chi Squared test. 231 subjects accepted for HT compared to 62 subjects requiring hospital admission. Forward logistic regression analysis | Typical crisis resolution team however only provided 12-hour service daily including weekends. | Hypo manic presentation Personality disorder High suicidal ideation (p < 0.01) Previous hospital admission (p < 0.01) |
Dean C1990 [12] UK | 65 subjects treated by HT compared to 34 subjects admitted to hospital. Chi-squared test. | Typical crisis resolution team. | Assessment outside office hours. Assessment in hospital or police station as opposed to home or outpatients Living alone. Not married. Younger (men). Previous admissions. Previous compulsory admissions. Violent during episode of illness. |
Harrison J 2001 [14] UK | 101 accepted onto HT compared to 94 refused HT. Forward stepwise logistic regression analysis | Twenty-four hour service with treatment offered either in patients own home or at the team base. Hybrid between day hospital and home treatment. Likelihood of being accepted to home treatment main outcome. | Diagnosis of less severe disorder (not Schizophrenia-spectrum or severe mood disorder) less likely to be accepted to home treatment. Location of referral not in community or outpatients less likely to be accepted. Out of 9 am–5 pm hours referrals less likely to be accepted. Referral from less senior practitioner less likely to be accepted. |
Bracken P 1999 [13] UK | 53 patients admitted to HT versus 63 admitted to hospital. Chi-squared test. | Typical crisis resolution team. Decision to admit to hospital or home treatment team made by sector or on-call consultant. | Not on CPA. Less likely to have a severe mental illness such as schizophrenia and manic depression. Primary diagnosis of personality disorder. Primary diagnosis of drug/alcohol problems. |
Abas M 2003 [17] New Zealand | Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit. Descriptive analysis only | Alternative care package included residential facilities with different levels of support, or home visits from a mental health nurse at least once a day. 'Crisis Team' gate keep all admissions. No further information is given however on the intervention provided by the crisis team. | Functional psychosis and marked social deprivation. Reasons cited for admission: reinstatement of medication, intensive observation, risk to self and risk to others. |
Guo S 2001 [20] USA | Matched case-control study of 4,106 subjects who had hospital based intervention compared to 1,696 subjects that had crisis intervention. Cox proportion hazards model. | Community-based mobile crisis program provided by a multidisciplinary team including crisis intervention specialists, registered nurses and psychiatrists. The team would review a case, attempt to stabilize the crisis recommend appropriate services and provide follow-up. ? Round the clock cover. | Referred by legal system Referred by psychiatric hospital or other treatment facility Primary diagnosis of schizophrenia, affective psychosis or other psychosis. Primary presenting problem being a suicidal gesture. Not with a primary diagnosis of drugs or alcohol dependency. Homeless Unemployed |
Schnyder U 1999 [21] Switzerland | Of 3611 psychiatric emergencies 1093 cases offered no further intervention were compared to 1287 cases offered outpatient crisis intervention and 1231 cases admitted to hospital. Chi-squared followed by logistic regression analysis | Outpatient crisis intervention offered but little more information is given about what this comprises. | Referral by police or by health professionals Diagnosis of psychotic disorder History of previous hospitalization Other factors: Male Single or divorced Living alone Less skilled worker/unemployed Less likely to self refer More previous hospital admissions More severe conditions |
Slagg NB 1983 [18] USA | Characteristics of three dispositional groups of 50 randomly selected subjects each were compared Multivariate analysis and validated in a second sample | Outpatient crisis program, which offers 6 visits, initiated within 24 hours of evaluation and program attempts to link patients to continuing treatment services if appropriate. | More psychologically impaired Psychotic Unlikely to self-refer Educated Unemployed Expressing acting out behaviour |
Segal S 1996 [22] USA | Interviewed? non-psychiatric Clinicians regarding their disposition decisions of 425 patients attending psychiatric emergency services. Multivariate analysis | Less restrictive alternative included supervised residential placement, including a placement with willing and responsible relative, crisis housing, halfway houses, board and care homes and foster family care. | Less engagement/cooperation with clinician Referral by police |
Walsh SF 1986 [15] USA | Compared 30 Emergency housing project (EHP) failures with 30 who were maintained and treated at the EHP Bi-variate discriminate function analysis | The emergency housing project is a short-term transitional residential setting designed to enable acutely ill psychiatric patients to be treated in the community as outpatients. Housed in a single room occupancy hotel staffed 24 hours a day by mental health workers supervised by a clinical social worker. The goals include psychological and social stabilization of the patient. Median length of stay is 11.2 days. Staff does not supervise medication. | Use of illicit substances Non-compliance with medication Uncooperatively with agencies |