Abstract
Aims and method To describe the clinical and demographic characteristics of all in-patients experiencing delayed discharge over 3 months in an English urban mental health National Health Service trust. We carried out a cross-sectional case record study with care coordinator questionnaire.Results Overall, 67 in-patients with delayed discharge occupied 18.6% of acute beds. Older in-patients were White, diagnosed with dementia and experienced relatively short admissions. Younger in-patients were often of Black and minority ethnic background with a psychotic diagnosis and long service contact, and sometimes experienced very long admissions. They were similar to a long-stay comparison group. The whole cohort was socially isolated and marginalised, and frequently misused alcohol.Clinical implications People with complex mental health problems can experience long stays in acute care settings. This particularly affects people with psychosis who are isolated in the community. Alcohol misuse is the most common complicating factor. There are insufficient community-oriented rehabilitation services to meet these patients’ diverse needs.
Highlights
This study aims to describe the clinical and demographic characteristics of a group of people regarded as delayed discharge in-patients in an urban mental health service in England
This was achieved by collecting information on: (a) people identified as delayed discharge patients on census day 1
Our study suggests that the problem of delayed discharge was not improving in 2009-2010
Summary
There were 142 acute in-patient beds across 7 wards and 18 beds on 2 psychiatric intensive care units (PICUs). In the 3-month sampling period, 67 people were recorded as delayed discharge patients; 16 of them were under the care of the older adult service. The second largest group (15.9%) had a primary diagnosis of dementia All of the latter were under the care of the older adult service. A majority of younger delayed discharge (n = 40, 78.5%) and long-stay (n = 10, 83%) patients had been admitted previously, but this was true of only a minority of older delayed discharge patients (n = 6, 37.5%). One older adult team with a good record of getting patients out of hospital in a timely way had no contact between CPA coordinators and patients during in-patient stays as a matter of clinical policy. There were a handful of people with intractable and apparently irresolvable problems, for example, failed asylum seekers with no right to funding
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