Service use and outcomes of first-admission patients with psychotic disorders in the Suffolk County Mental Health Project.
OBJECTIVE
The purpose of the study was to examine the inpatient and outpatient service use and 4-year outcomes of newly admitted psychotic patients during a period of rapid change in the provision of psychiatric services in a well-defined catchment area in New York State in the 1990s.


METHODS
Subjects were 573 participants of the Suffolk County Mental Health Project. This group comprised patients with psychotic disorders first admitted between September 1989 and August 1995 to 12 inpatient facilities across Suffolk County, N.Y., and followed for up to 48 months. The subjects' service use, course of illness, symptomatic outcomes, suicide risk, homelessness risk, and satisfaction with care were compared across admission years.


RESULTS
The length of inpatient stays decreased significantly across the years. However, the number of outpatient visits and therapy sessions did not vary. Although the patients admitted in later years were more symptomatic at admission to their first hospitalization, their course and outcomes over the follow-up period were not worse and they were not less satisfied with their care, compared with the patients admitted in earlier years.


CONCLUSIONS
The clinical characteristics of patients and the role of inpatient care in the management of patients with psychotic disorders gradually changed during the 1990s. These changes, however, were not associated with changes in the use of outpatient services or outcomes. Nevertheless, shorter hospital stays and the presence of more severely ill patients highlight the need for more attention to linkage to aftercare and enhancement of support networks in the community.
Mojtabai
Ramin
R
Department of Psychiatry, Beth Israel Medical Center, First Ave. at 16th St., New York, NY 10010, USA. rm322@columbia.edu
Herman
Daniel
D
Susser
Ezra S
ES
Sohler
Nancy
N
Craig
Thomas J
TJ
Lavelle
Janet
J
Bromet
Evelyn J
EJ
D000328:Adult; D000359:Aftercare / Q000592:standards / Q000639:trends; D000553:Ambulatory Care / Q000706:statistics & numerical data / Q000639:trends; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data* / Q000639:trends; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D018166:Health Care Reform / Q000706:statistics & numerical data / Q000639:trends; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D012944:Social Support; D013405:Suicide / Q000706:statistics & numerical data