Psychiatric Hospitalization: Reasons for Admission and Alternatives to Admission in South Auckland, New Zealand

• Published in: Australian and New Zealand journal of psychiatry Vol. 37; no. 5; pp. 620 - 625
• Main Authors: Abas, Melanie, Vanderpyl, Jane, Le Prou, Trix, Kydd, Rob, Emery, Brian, Alo Foliaki, Siale
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-10-2003; Blackwell Science Pty; Informa
• Subjects: Admissions; Adult; Bed Occupancy - economics; Bed Occupancy - statistics & numerical data; Biological and medical sciences; Catchment Area (Health); epidemiology; Evaluation; Female; health services needs and demands; health services research; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Humans; Institution therapy. Inpatient treatment; Length of Stay; Male; Medical sciences; mental disorders; Mental health; mental health services; New Zealand; New Zealand - epidemiology; Organization of mental health. Health systems; Outcome Assessment (Health Care); Patient Admission - economics; Patient Admission - statistics & numerical data; psychiatric; Psychiatric units; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - economics; Psychotic Disorders - rehabilitation; Reasons; Social psychiatry. Ethnopsychiatry; Surveys; Treatments; New Zealand; Oceania; mental disorders/epidemiology; psychiatric; health services research; hospitals; mental health services; health services needs and demands; Social environment; Socioeconomic status; Prevalence; Accessibility; Social need; Mental health; Forced hospitalization; Health service; Epidemiology; Psychosis; Motivation; Diagnosis; Public health; Human; Hospital admission; Geographical origin; Recommendation; Marital status; Treatment; Sociodemographic factor; Public health organization; Mental disorder; Comparative study
• ISSN: 0004-8674; 1440-1614
• DOI: 10.1046/j.1440-1614.2003.01229.x

Objective: To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit.
Method: Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit in Auckland, using interviews with staff and case note review.
Result: Most patients had a functional psychosis and were admitted involuntarily. Forty percent came from areas of marked social deprivation. The major reasons for admission were for reinstatement of medication (mainly linked to non-concordance with prescribed medication), intensive observation, risk to self and risk to others. Only 12% of admissions could have been diverted, of whom most would have required daily home treatment. For those still admitted at 5 weeks, 26% could have been discharged, mainly to 24 h nurse-staffed accommodation. If the alternatives had all been available, simulated bed-day savings were 11 bed years per year. Simulated bed day savings were greater through implementing early discharge than by diverting new admissions.
Conclusion: Greater availability of assertive community treatment and of interventions to improve medication concordance may have prevented a small number of admissions. For patients admitted longer than 5 weeks, it appeared that greater availability of 24 h nursestaffed accommodation would have allowed considerable bed-day savings.