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An analysis of the utilization of inpatient care by severely and persistently mentally ill adults in a public mental health system
Records of 667 of 1242 Western Massachusetts Department of Mental Health clients, meeting age and diagnostic criteria established for the study, were analyzed for their use of inpatient and community mental health services. Clients from four geographic areas were compared on the dependent variables: admissions and inpatient days per year, before and after the initiation of community mental health services. Socio-demographic and clinical variables, as well as the utilization of community mental health services also were measured for each individual. Dramatic reductions in the utilization of inpatient care were demonstrated, with admissions per year decreasing by 56%, from 1.40 to.61; and inpatient days per year decreasing by 80% from 128 to 28. Increased admissions were related to increased use of outpatient care, medication services, diagnosis of Major Mood Disorders, shorter total duration in the mental health system, fewer inpatient days prior to community mental health services and increased inpatient days after community mental health services. Increased inpatient days were associated with increases in education, total years in the mental health system, years in community mental health services, admissions prior to community mental health services, and decreased use of outpatient therapy. Decreased admissions were related to increases in the use of inpatient days prior to community mental health services. Decreased inpatient days were associated with the use of staffed residential, day treatment, and other day programs, as well as increased admissions prior to community mental health services, and years in the mental health system. The use of community mental health services in predicting decreased inpatient utilization improved the R$\sp2$ by 16.7%. There were no differences in patterns of inpatient utilization among catchment areas after initiating community services, although differences existed in mix and availability of services, as well as resources. The availability of selective community services were related to inpatient utilization. It is suggested that there may be a threshold of service availability beyond which additional resources, although they may contribute to the quality or diversity of opportunities, do not impact inpatient utilization. These findings suggest that the paradigm for future research must included service variables in the predictive models.
Mental health|Public health|Demographics
Mitchell, Mark Robert, "An analysis of the utilization of inpatient care by severely and persistently mentally ill adults in a public mental health system" (1998). Doctoral Dissertations Available from Proquest. AAI9823759.