In the most comprehensive study of its kind, researchers have found that the inpatient length of stay for youth with mental illness fell more than sixty percent between 1990 and 2000, despite concurrent increases in illness severity and self-harm, and declining transfers to intermediate and inpatient care within the same population.
Lead author, Brady Case, MD, with the Bradley Hasbro Children’s Research Center, the Brown Medical School Division of Child and Psychiatry Fellowship Program, and the New York University School of Medicine, analyzed data from one thousand community hospitals nationwide and found that in the course of a decade, the average length of inpatient hospitalization for youth undergoing mental health treatment declined from 12.2 days to 4.5 days.
“These trends prompt serious questions about diagnostic practices and quality of care for children and adolescents with mental disorders,” says Case.
The study appears in the January 2007 issue of the Archives of General Psychiatry.
The authors found that children and adolescents treated for mental illness were discharged from community hospitals far more quickly in 2000 than ten years earlier. However, in the same year, more youth were diagnosed with psychotic, depressive, and bipolar disorders, and more were found to have intentionally harmed themselves. The total number and population rate of discharges did not change, but the total number of inpatient days and the average cost per visit each fell by approximately one half. They also report that transfers to short-term, nursing, and other inpatient facilities declined.
“During a decade which saw the emergence of managed mental health care and increased use of psychotropic medications by young people, our findings raise concerns about diagnostic practices and quality of inpatient care for mentally ill youth,” says Case.
While these findings reflect changes in diagnostic patterns for children and adolescents, the authors do not know if this trend is because youth treated in hospitals are increasingly ill, or because the understanding of pediatric mental illness has evolved, or because mental health providers must indicate more severe diagnoses to obtain payment.
“Most troubling is the possibility that, driven by financial and other pressures, mental health providers are discharging severely ill youth too early in treatment. However, it may be that mental health providers are using hospital resources more efficiently and that children are increasingly being treated safely in day programs, clinics, and private offices,” says Case.
Inpatient stays at Bradley Hospital, the nation’s first psychiatric hospital for children and adolescents, seem to concur with this study.
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Sub-editorYouth are receiving shorter inpatient stays for mental health treatment
by Sub-editor ( Author at Spirit India )
Posted on January 4th, 2007 at 10:07 pm.
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