Psychiatric admissions and hospitalization in Israel: an epidemiologic study of where we stand today and where we are going.
BACKGROUND
Analysis of the trends in psychiatric admissions and discharges is necessary to correctly plan and distribute resources, especially given the current international climate of "deinstitutionalization." Israel, too, is implementing "reform" in the national psychiatric system - to transfer psychiatric treatment from a hospital to a community setting.


OBJECTIVE
To analyze admission and discharge patterns, explore trends in psychiatric hospital length of stay, and compare these characteristics between first-episode and chronic patients, between children, youth and adults, and between hospitals.


METHODS
All admissions and discharges from inpatient psychiatric wards between the years 2000 and 2004 were analyzed and characterized according to age, length of hospitalization, legal status, and nature of admitting institution (state hospital, health fund, general hospital).


RESULTS
Mean length of stay in adults decreased during the 5 year study period, from 37.6 days in 2000 to 36.4 days in 2004. In years with higher admissions, hospital stay was shorter (P < 0.05). Length of stay in psychiatric wards in general hospitals was shorter than in state hospitals (P < 0.001). In contrast to adults and children, length of stay among adolescents showed a gradual increase (P < 0.05). Involuntary hospitalization comprised 25.3% of all admissions, and 16.8% of discharged patients were re-admitted within 30 days. A dramatic decrease (24.3%) in the number of chronic hospitalizations was noted.


CONCLUSIONS
Various factors may account for these developments. Protracted hospitalizations may be reduced through changes in various aspects of treatment planning and psychiatric care continuum. The decrease in number of admissions, length of stay and number of chronically admitted patients remains in line with international practices. Particular attention needs to be devoted to planning and funding so that availability of community services matches reduction in psychiatric hospitalization.
Baruch
Yehuda
Y
Abarbanel Mental Health Center, Bat Yam, Israel.
Kotler
Moshe
M
Lerner
Yaakov
Y
Benatov
Joy
J
Strous
Rael D
RD
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D018166:Health Care Reform / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D001523:Mental Disorders / Q000453:epidemiology