Abstract
BackgroundCommunity residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI).AimsTo investigate use of community and specialised mental health care services and costs in patients with SMI the first 12 months after discharge from a mental health hospital (MHH), comparing community residential aftercare (CRA) and treatment as usual.MethodsAn open parallel group randomised controlled trial with 41 participants. Data on use of specialist services (hospital, ambulant treatment and outpatient treatment) and community services (residential stays, home help, home care nursing, mental health consultation) were collected from specialist and community registers and health records.ResultsFor the primary outcome, utilisation of community mental health services, the intervention group used, on average, 29% fewer hours (mean differences − 21.6 h, 95% CI -93.1 to 44.9, p = .096) with a cost saving of 29% (mean differences − 1845 EUR, 95% CI -8267 to 4171, p = .102), but the estimates were imprecise. For the secondary outcome, the study groups had the same total number of inpatient days (66 days), but the intervention group had on average of 13.4 fewer inpatient days in the mental health hospital (95% CI -29.9 to 0.9. p = .008). The number of inpatient admissions (mean difference − 0.9 admissions, 95% CI -3.5 to 1.5, p = .224) and readmissions (− 0.8, 95% CI -2.5 to 0.9. p = .440) was lower in the intervention group. The intervention group had on average a total cost saving of 38.5% (mean differences − 23,071 EUR, 95% CI -45,450 to 3027. p = .057). A post hoc multivariable regression analysis controlling for baseline characteristics gave a reduction in total cost in favour of the intervention group of − 19,781 EUR (95% CI -44,072 to 4509, p=,107).ConclusionIn this study, it was not possible to draw a definite conclusion about the effect, due to the small sample and imprecision of the estimates. The direction of the results and size of the point estimate, in addition to findings in other studies, indicates that transferring patients ready for discharge from mental hospital to community residential aftercare can have the potential to reduce total consumption of health services and costs without increased hospital admissions.Trial registrationRegistered in clinicaltrials.gov (NCT01719354)
Highlights
Community residential aftercare services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI)
In the weekly meetings between the researcher and the contact nurses, the nurses reported that almost all participants who were introduced to the study, said that they would participate
− 413 (− 1784 to 457) .758 (Table 5), but patients randomised to the community residential aftercare (CRA) had 54% fewer inpatient days in the mental health hospital (MHH)
Summary
Community residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI). Most psychiatric inpatients can be discharged without comprehensive follow-up, yet patients with severe mental illness (SMI) often need long-term aftercare [1]. This is a vulnerable group, as patients with SMI have a 10–25 year shorter life expectancy than the general population [2]. It is a challenge to provide timely community services for patients who are ready for discharge from mental health hospitals. A review of 35 studies, mostly from general hospitals, on delayed discharge [8] found that the average cost of one extra day per patient was between £200 and £565
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