Associations of homelessness and residential mobility with length of stay after acute psychiatric admission.
Loading...
Authors
Tulloch, Alex D
Khondoker, Mizanur R
Fearon, Paul
David, Anthony S
Issue Date
2012-08-21
Type
Journal Article
Research Support, Non-U.S. Gov't
Research Support, Non-U.S. Gov't
Language
en
Keywords
Alternative Title
Abstract
A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures.
Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression.
Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor.
Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.
Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression.
Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor.
Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.
Description
Citation
Tulloch, A. D., Khondoker, M. R., Fearon, P., & David, A. S. (2012). Associations of homelessness and residential mobility with length of stay after acute psychiatric admission. BMC psychiatry, 12, 121. https://doi.org/10.1186/1471-244X-12-121
Publisher
License
Journal
BMC psychiatry
Volume
12
Issue
PubMed ID
DOI
10.1186/1471-244X-12-121
10.1001/archgenpsychiatry.2011.84
10.1192/bjp.185.4.334
10.1007/s10488-010-0310-3
10.1080/09638230050009140
10.1017/S003329170002910X
10.1034/j.1600-0447.2001.00043.x
10.1111/j.1600-0447.1999.tb10849.x
10.1007/BF01788632
10.1007/BF00802097
10.1192/bjp.172.1.11
10.1192/bjp.171.3.242
10.1056/NEJM199806113382406
10.1097/00005650-200010000-00004
10.1007/s00127-008-0332-2
10.1111/j.1467-9515.2004.00416.x
10.1177/002076409904500202
10.3109/09638239208991563
10.1093/oxfordjournals.pubmed.a024481
10.1136/bmj.314.7076.262
10.1177/0020764003049002004
10.1192/bjp.150.5.621
10.1046/j.1365-2524.1999.00156.x
10.1097/00005650-199808000-00013
10.1016/0277-9536(84)90249-1
10.1016/j.healthplace.2006.02.001
10.1007/s00127-006-0150-3
10.1007/s10488-007-0130-2
10.1007/s00127-009-0115-4
10.1007/s00127-011-0414-4
10.1016/j.healthplace.2011.05.006
10.1186/1471-244X-9-51
10.1002/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R
10.1002/sim.4067
10.1093/ije/28.5.964
10.1080/02664760802553000
10.1097/00005650-198407000-00002
10.1097/00005650-198905000-00009
10.1001/archpsyc.1985.01790290030003
10.2307/145966
10.1023/A:1020154012982
10.1007/s001270050199
10.1093/pubmed/fdm026
10.1001/archgenpsychiatry.2011.84
10.1192/bjp.185.4.334
10.1007/s10488-010-0310-3
10.1080/09638230050009140
10.1017/S003329170002910X
10.1034/j.1600-0447.2001.00043.x
10.1111/j.1600-0447.1999.tb10849.x
10.1007/BF01788632
10.1007/BF00802097
10.1192/bjp.172.1.11
10.1192/bjp.171.3.242
10.1056/NEJM199806113382406
10.1097/00005650-200010000-00004
10.1007/s00127-008-0332-2
10.1111/j.1467-9515.2004.00416.x
10.1177/002076409904500202
10.3109/09638239208991563
10.1093/oxfordjournals.pubmed.a024481
10.1136/bmj.314.7076.262
10.1177/0020764003049002004
10.1192/bjp.150.5.621
10.1046/j.1365-2524.1999.00156.x
10.1097/00005650-199808000-00013
10.1016/0277-9536(84)90249-1
10.1016/j.healthplace.2006.02.001
10.1007/s00127-006-0150-3
10.1007/s10488-007-0130-2
10.1007/s00127-009-0115-4
10.1007/s00127-011-0414-4
10.1016/j.healthplace.2011.05.006
10.1186/1471-244X-9-51
10.1002/(SICI)1097-0258(19990330)18:6<681::AID-SIM71>3.0.CO;2-R
10.1002/sim.4067
10.1093/ije/28.5.964
10.1080/02664760802553000
10.1097/00005650-198407000-00002
10.1097/00005650-198905000-00009
10.1001/archpsyc.1985.01790290030003
10.2307/145966
10.1023/A:1020154012982
10.1007/s001270050199
10.1093/pubmed/fdm026
ISSN
1471-244X