The Lengths of Psychiatric Hospital Stays and Community Stays

The public policy of deinstitutionalization has predominated mental health planning and decision-making in recent decades. The government and consumer groups have joined together to find ways to decrease the state mental hospital inpatient population. There is a consistent belief in the need to reduce the utilization of inpatient care that has resulted in a decline from 413,066 state mental hospital beds in 1970 to 93,058 in 1992 (Redick et al. 1996). However, there is ongoing concern about the utilization of inpatient care. Particular concern relate to the length of inpatient stays and the readmission to inpatient care following discharge. State mental hospitals have longer median lengths of stays for discharged clients than other types of psychiatric inpatient facilities (Rosenstein et. al. 1990). A study including data from eleven states on all of the state psychiatric hospitals clients for a four year time period showed that 25% of the clients were hospitalized for over four years (Leginski et. al. 1990). Of the clients with lengths of stay less than four years, 50% had one or more prior inpatient visits within four years. Fisher, et. al. (1992) empirically challenged the accepted belief that increasing community resources for the provision of outpatient and other types of community based care reduces the use of inpatient care, particularly through decreasing readmissions. They used a naturally occurring experiment where a set of counties had twice the community resources as other counties in the state. Although there was less utilization of inpatient care, it was due to less use by long term patients than by patients with stays of 90 or fewer days. Survival analysis was used to show that there was little difference in community tenure among the regions. They determined that in all but one region, there was a 50% chance that a patient discharged from a state hospital would not be readmitted in four years. Due to the cost of inpatient care and its restriction on the freedom of clients, there is continual effort to find ways to reduce its utilization. This study explores in depth the characteristics of clients and communities that influence the length of inpatient stay and length of the stay in the community following discharge from inpatient care, termed community tenure, for clients treated in state hospitals of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS). Its findings offer additional information on the utilization of inpatient care, particularly on factors that influence length of stay and subsequent community tenure. In order to reduce further the use of inpatient care, it is necessary to understand the relationship between length of stay and the pattern of care within the inpatient stay and subsequent community tenure.