Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

Abstract

Background: To return the patients to primary care is arguably the desired service outcome for community mental health teams (CMHTs).Aims: To assess acute mental health service use (hospitalisation or Home Treatment Team) by people with severe mental illness following discharge to primary care.Method: Retrospective cohort study comparing receipt and duration of acute care by 98 patients in the two years following discharge to primary care from CMHT, with a cohort of 92 patients transferred to another CMHT.Results: The discharged group was significantly more stable on clinical measures. Fifty-seven (58.2%) patients were re-referred after median 39 weeks, with 35 (60.3%) in crisis. The difference in acute service use between discharged patients (27.9 days/patient) and transferred patients (31.7 days/patient) was not significant. Hospitalisation in the two years prior to discharge or transfer increased the odds of re-referral (OR 3.93, 95% CI 1.44–14.55), subsequent acute service use (OR 1.02, 95% CI 1.01–1.03) and duration of input (0.45 extra days/patient, 95% CI 0.22–0.68).Conclusions: The majority of the discharged patients were re-referred to mental health services. Although these were more stable, there was no difference from the transferred group on acute service use. Further support may be required in primary care to maintain stability.