Psychiatric hospitalization: reasons for admission and alternatives to admission in South Auckland, New Zealand.
OBJECTIVE
To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit.


METHODS
Reasons for admission and alternatives to admission were rated for a consecutive sample of 255 admissions to an acute psychiatric unit in Auckland, using interviews with staff and case note review.


RESULTS
Most patients had a functional psychosis and were admitted involuntarily. Forty percent came from areas of marked social deprivation. The major reasons for admission were for reinstatement of medication (mainly linked to non-concordance with prescribed medication), intensive observation, risk to self and risk to others. Only 12% of admissions could have been diverted, of whom most would have required daily home treatment. For those still admitted at 5 weeks, 26% could have been discharged, mainly to 24 h nurse-staffed accommodation. If the alternatives had all been available, simulated bed-day savings were 11 bed years per year. Simulated bed day savings were greater through implementing early discharge than by diverting new admissions.


CONCLUSIONS
Greater availability of assertive community treatment and of interventions to improve medication concordance may have prevented a small number of admissions. For patients admitted longer than 5 weeks, it appeared that greater availability of 24 h nurse-staffed accommodation would have allowed considerable bed-day savings.
D000328:Adult; D001509:Bed Occupancy / Q000191:economics / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000191:economics / Q000534:rehabilitation*