Summary of the report Unnecessary admissions, patients ready to be discharged and collaboration concerning individual patients – the extent of and characteristics of the patients by Solveig Osborg Ose
We estimate that 7 % of patients in psychiatric health care are ready to be discharged and waiting for municipal services, while a corresponding share in spesialised treatment for substance use (TSB) is estimated at 1%. The reason for that the patients have not been discharged is usually the lack of a municipal accommodation service for them. Many of the practitioners and patients consider that the patient ready to be discharged needs a 24-hour accommodation service.
We find that patients waiting to be discharged more often have serious mental disorders, compared to patients who are not considered ready to be discharged. More often than not, they are men rather than women, have little education, have often been admitted for emergency assistance and a higher share of them are readmitted (within 30 days). The municipalities they come from are often larger cities and they have little networks (family/friends). These are patients who most likely are in need of extensive services from the municipalities, in addition to staffed or supervised care accommodation. Many municipalities will argue that with the resources they have at their disposal, these patients are too sick for them to be able to provide them with proper services. The specialist health care service and the municipality need to work closely together in order to provide these patients with an adequate service, also when the psychiatric health care service treatment is completed. These are patients that the municipalities cannot bear the sole responsibility for.
Therefore, there are not that many patients waiting to be discharged in psychiatric health care and TSB, but we do find that there lies great potential in avoiding admissions in the specialist health care service. We estimate that almost every fourth admission in psychiatric health care could have been avoided had various municipal services been established and developed. Around 10 % of the TSB admissions, we calculate, could have been avoided if the municipalities were able to offer a better service. So according to practitioners and patients, it is a great advantage to avoid admissions in the 24-hour institutions, but regardless, 25 % more of the 24-hour places cannot be removed now. The municipal services need to be further developed and include good preventive competence as well as a broad service both in terms of accommodation, low-threshold measures, support services (employment, day-care centre, contact person), adequate home services and more. In addition, it is also about motivating people with mental disorders and/or substance abuse problems to accept help from the municipalities. Many people are reluctant, and the reasons for that can be that they have experienced a lack of anonymity, bad experiences from previous contact and most importantly, people with mental disorders and substance abuse problems can have a different insight into their illness than representatives from the support system feel that they should have.
The collaboration between the specialist health care service and the municipalities concerning most patients in the survey’s selection function well, as assessed by practitioner and patient. In particular, a well-functioning team that is assigned responsibility for patients as well as a coordinator performing good work is important elements for this group of patients. Individual Plan (IP) is also often described as an important tool when coordination is successful. Many achieve frequent contact between the service levels over the phone. Several patients also get good help from NAV and from the ACT team and other collaborative groups. On those occasions where cooperation doesn’t exist or works poorly, it is often about accommodation services not having been agreed upon. It can also be that it takes a long time to get the necessary service in place, or that the patient does not want help from the municipalities. We don’t see that there lies great potential in commencing municipal payment for patients ready to be discharged from psychiatric health care and TSB. Municipal co-financing in order to prevent admissions can hold greater potential, because this involves many more patients. Whether or not this will lead to better services for the patients, however, is highly uncertain. Many people have an acute need for 24-hour treatment in the specialist health care service, regardless of the extent and quality of the municipal service, while for others admissions can be prevented by implementing the right measures in the municipality.
Most likely, the greatest potential lies in the patient acquiring services from the specialist health care service and the municipalities at the same time. Some make it work and the result then is cooperation, stability and efficiency in the services in the sense that the most suitable participant holds the task. The greatest potential for development probably lies in the area between the service levels. The ACT Team will provide continuous and comprehensive services from the municipalities and specialist health care services to people who are unable to seek help for themselves or do not see the need for it. Research has shown that fewer people need to be admitted in psychiatric health care after having received help form an outreach ACT team. ACT teams should therefore be an area of priority for the binding cooperation between the service levels from now on.
The report can be downloaded here (only in Norwegian)
From the project: Cooperation concerning the patients in psychiatric health care