The Revolving Door Phenomenon in the Romanian Mental Health System

Abstract

Background: Hospitalized at least three times in a two-year period, have emerged as an unintended side effect of the deinstitutionalization of mental health in high-income countries. Guaranteeing access to high-quality outpatient services has shown to be the most effective method for alleviating the revolving door phenomenon. In Eastern Europe, deinstitutionalization is ongoing, 0 but the phenomenon has received little attention. The present cross-sectional study examined the revolving door phenomenon in the largest psychiatric inpatient unit in Bucharest, Romania.

Methods: Socio-demographic healthcare use and clinical characteristics of 144 patients were collected following admission to the "Profesor Doctor Alexandru Obregia" Psychiatric Hospital via an initial visit conducted between September 2022 and January 2023. A follow-up check occurred one year later to evaluate the number of readmissions and compare those who met the criteria for revolving door status at follow-up with those who did not. After identifying factors associated with revolving door status by univariate analysis, a bivariate model included the results to account for reciprocal moderating effects.

Results: In total, 56 (38.9%) patients met the criteria for revolving door status. The number of lifetime hospitalizations was significantly higher in the revolving door group (odds ratio (OR) = 3.956, p ≤ 0.001), while involuntary admission on the initial visit decreased the odds of receiving a revolving door status on follow-up (OR = 0.188, p = 0.008). Revolving door patients had less time between readmissions than controls (OR = 0.991, p < 0.001).

Conclusions: Frequent hospitalization was the primary factor predicting revolving door status in the cohort studied, reflecting the Romanian mental health system's focus on inpatient care. This illustrates the need for reliable outpatient care as an alternative to hospital admission to avoid the self-perpetuating cycle of repeated admissions that are inefficient both from an economic and medical standpoint.

Keywords: clinical epidemiology; community mental health services; health care.