Abstract
International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.
Highlights
The burden of mental disorders worldwide is high
The considerable variations in the length of stay (LOS) between psychiatric sectors observed in France are of the same order of magnitude as those underscored by a study carried out on depressed patients in 107 medical centres in the US, which showed that there was a fourfold difference in the mean LOS between the medical centres with the shortest and the longest LOS [78]
Our results provide the first evidence of the benefits of developing alternatives to full-time hospitalizations (AFTH) in the French setting as the reduction of the LOS in full-time hospitalization is in alignment with international recommendations for mental health care [13,22,23,24]
Summary
The burden of mental disorders worldwide is high. They will affect one in three individuals over the course of their lifetime [1], and are anticipated to become the leading cause of disability-adjusted life years by 2020 [2,3]. The costs associated with mental disorders are considerable They account for 8% of the total national health spending and represent the first item of expenditures for Statutory Health Insurance [7,8]. A major challenge of the mental health care system in France is providing optimal care to confront this epidemiological and economic burden. This system is characterized by a territorial
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