title: Acute mental health service use by patients with severe mental illness after discharge to primary care in South London.
abstract: BACKGROUND
  To return the patients to primary care is arguably the desired service outcome for community mental health teams (CMHTs).
  
  
  OBJECTIVE
  To assess acute mental health service use (hospitalisation or Home Treatment Team) by people with severe mental illness following discharge to primary care.
  
  
  METHODS
  Retrospective cohort study comparing receipt and duration of acute care by 98 patients in the two years following discharge to primary care from CMHT, with a cohort of 92 patients transferred to another CMHT.
  
  
  RESULTS
  The discharged group was significantly more stable on clinical measures. Fifty-seven (58.2%) patients were re-referred after median 39 weeks, with 35 (60.3%) in crisis. The difference in acute service use between discharged patients (27.9 days/patient) and transferred patients (31.7 days/patient) was not significant. Hospitalisation in the two years prior to discharge or transfer increased the odds of re-referral (OR 3.93, 95% CI 1.44-14.55), subsequent acute service use (OR 1.02, 95% CI 1.01-1.03) and duration of input (0.45 extra days/patient, 95% CI 0.22-0.68).
  
  
  CONCLUSIONS
  The majority of the discharged patients were re-referred to mental health services. Although these were more stable, there was no difference from the transferred group on acute service use. Further support may be required in primary care to maintain stability.
authors.affiliation: a General Adult Psychiatry, South London and Maudsley NHS Foundation Trust , London , UK .
authors.forename: Parashar P
authors.initials: PP
authors.lastname: Ramanuj
authors.affiliation: b European Programme for Intervention Epidemiology Training (EPIET) Fellow, Public Health England , London , UK .|c European Centre for Disease Prevention and Control , Stockholm , Sweden .
authors.forename: Carlos F A
authors.initials: CF
authors.lastname: Carvalho
authors.affiliation: d Psychosis Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK .
authors.forename: Robert
authors.initials: R
authors.lastname: Harland
authors.affiliation: e Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK .|f Psychosis Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK , and.
authors.forename: Philippa A
authors.initials: PA
authors.lastname: Garety
authors.affiliation: g Health Service and Population Research Department , Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK.
authors.forename: Tom K J
authors.initials: TK
authors.lastname: Craig
authors.affiliation: d Psychosis Clinical Academic Group , South London and Maudsley NHS Foundation Trust , London , UK .
authors.forename: Nicola
authors.initials: N
authors.lastname: Byrne
mesh_terms: D000208:Acute Disease; D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010351:Patient Discharge; D011320:Primary Health Care; D012189:Retrospective Studies; D013997:Time Factors
keywords: Community mental health; discharge; primary care; resource utilization