title: Needs-oriented discharge planning for high utilisers of psychiatric services: multicentre randomised controlled trial.
abstract: OBJECTIVE
  Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary).
  
  
  METHODS
  Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge.
  
  
  RESULTS
  Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes.
  
  
  CONCLUSIONS
  Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.
authors.affiliation: Department of Psychiatry II, Ulm University, Günzburg, Germany. bernd.puschner@bkh-guenzburg.de
authors.forename: B
authors.initials: B
authors.lastname: Puschner
authors.forename: S
authors.initials: S
authors.lastname: Steffen
authors.forename: K A
authors.initials: KA
authors.lastname: Völker
authors.forename: C
authors.initials: C
authors.lastname: Spitzer
authors.forename: W
authors.initials: W
authors.lastname: Gaebel
authors.forename: B
authors.initials: B
authors.lastname: Janssen
authors.forename: H E
authors.initials: HE
authors.lastname: Klein
authors.forename: H
authors.initials: H
authors.lastname: Spiessl
authors.forename: T
authors.initials: T
authors.lastname: Steinert
authors.forename: J
authors.initials: J
authors.lastname: Grempler
authors.forename: R
authors.initials: R
authors.lastname: Muche
authors.forename: T
authors.initials: T
authors.lastname: Becker
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000523:psychology / Q000592:standards*; D003156:Community Mental Health Services / Q000592:standards*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D011788:Quality of Life; D012720:Severity of Illness Index