[Psychiatric admissions, continued hospital stay and community psychiatric treatment. Quality assurance of admission practice]

Abstract

Investigations on psychiatric admissions and length of stay at hospitals show great variations that are difficult to explain and many factors, besides relevant clinical ones, have been shown to contribute. Short hospital stays do not, in contrast to common beliefs, seem to increase the rehospitalization rate, more likely the opposite. Several places in the world have established criteria for "good practice" which use few and short intakes in combination with intensive community treatment. The results (symptoms and function) are better, the satisfaction of patients and relatives greater and the cost unchanged or less. The results have been reached by the use of "therapist case managers" in a psychiatric team. The use of coordinating case managers seems to increase hospital use. There is a need for intensive community psychiatry carried out on the patients' terms. Inpatient treatment must be a part of the system. Concurrent quality assurance of the criteria for use is recommended.