Abstract
Among the different types of heavy use of mental health services, frequent inpatient admission in acute care units of individuals unable to return to their usual environment refers to as revolving-door (RD). RD in prisoners is related to increased violence (acted and supported) and suicidal recidivism. We explored the determinants of RD in 200 inmates from the Swiss-French speaking areas who were admitted to the sole acute psychiatric care unit for all of the Swiss-French counties, located in Geneva. The Cuzick's test for trend across ordered groups, Kruskal-Wallis test and oneway ANOVA were used to compare demographic and clinical variables between single (one admission, N = 100), frequent (3–7, N = 69) and RD (more than 8, N = 31) during a 12 months period. In addition, univariate and multivariable ordered logistic regression modes were built to examine the determinants of RD. The sample included 27 women (mean age: 31.2 years) and 173 men (34.5 years) who were admitted during the period 2014–2019. The vast majority were single (65%) with low level of education (<6 years, 78%). Suicidal behavior was the more frequent reason for admission (57%). Psychiatric history was positive in 77.5% of cases and in 54.5% of cases there was at least one episode of inpatient psychiatric care. The more frequent ICD-10 psychiatric diagnosis in the last admission were psychotic disorder (38%), personality disorder (29.5%) and adjustment disorder (19.5%). In contrast, depressive episodes (7%) and bipolar disorder (4.5%) were rare. Group comparison showed that the presence of court-ordered treatments, suicidal behavior, personality and psychotic disorders was associated with significantly increased frequency of RD use. In univariate models, the same factors were positively associated with RD, the highest odds ratio being found for court-ordered treatments (5.77) and personality disorders (2.14). In contrast, the diagnosis of adjustment disorders was related to decreased RD use (OR 0.25). Court-ordered treatments and personality disorders were the only factors to predict RD in multivariable regression models. These findings suggest that acute psychiatric care in these patients did not depend of environmental stressors but rather represents the expression of a long-lasting vulnerability related to their psychological profile and criminal status.
Highlights
Heavy use of mental health services refers to the disproportionate consumption of psychiatric care and is often associated with significant cost increase and team frustration [1]
In the absence of previous studies regarding RD use in psychiatric settings for forensic patients, one should compare these observations with those made in adult psychiatry
Cases with drug discontinuation causing hospital stays were excluded from the present analysis in order to focus on long-term determinants of RD in forensic patients
Summary
Heavy use of mental health services refers to the disproportionate consumption of psychiatric care and is often associated with significant cost increase and team frustration [1]. RD indicates repeated hospitalizations of patients unable to sustain an independent life in the community [4, 5]. This phenomenon accounts for almost 16% of hospital days but concerns < 3% of psychiatric inpatients [6]. Repeated admissions to a psychiatric facility are considered as a poor outcome, since they have a negative impact on patient well-being and mortality and dramatically rises mental health-related costs [8, 9]. Environmental factors can influence this phenomenon: an urban environment [12] and, even more, family conflicts [26] could increase the tendency for repeated hospitalizations
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