Winkler P, Mladá K, Krupchanka D, Agius M, Manaan Kar-Ray, Höschl C. Long term inpatients with psychoses discharged from Czech mental hospitals in 2006-2011. Abstracts of the 5th Biennial Cambridge & Bedford International Conference on Mental Health. Clare College, Cambridge University 11-14 Sept 2015

11. 9. 2015 - 14. 9. 2015


Departments:

Department of Social Psychiatry, National Institute of Mental Health, Czech Republic

Health Service and Population Research Department, King’s College London

Clare College, University of Cambridge

Acknowledgement: This work was supported by the project “National Institute of Mental Health, Czech Republic”, Grant number CZ.1.05/2.1.00/03.0078, European Regional Development Fund.

Aims: Mental health care in many post-communist Central and Eastern European countries still relies on large mental hospitals. The Czech Republic has announced a reform strategy in 2013, but its population of long term psychiatric inpatients is largely unknown. We aimed to assess a prevalence of long term hospitalizations among those with non-mood psychotic disorders (ICD10, F20-F29) who were discharged from Czech mental hospitals between 2006 and 2011. The other aim was to assess deaths during hospitalization, reinstitutionalization, and rehospitalizations that followed these patients’ discharges.

Methods: The Czech register of all inpatient hospitalizations was linked with the Czech register of all-cause deaths. The cohort of discharged long-term patients was described and logistic regression analysis was performed in order to asses the odds of rehospitalization.

Results: Between 2006 and 2011, 21,538 patients with non-mood psychotic disorders (ICD10, F20-F29) were discharged from Czech mental hospitals. This included 9.5 % (n=2,042) of those whose hospitalization was longer than a year. Approximately a half (n=1,035) were patients previously hospitalized for more than four years, and this included 335 of those hospitalized for more than 20 years. More than two hundred (11.7 %) of the long term patients died within the hospitalization. More than four hundred (20.1 %) of long term patients were re-institutionalized into either, social or health care facility. More than one fourth (n=522) of discharged patients with psychosis were rehospitalized within 2 weeks after the discharge. The odds of rehospitalization were associated with the way of discharge and the highest odds were found for those who were discharged against medical advice (OR 4.36, CI: 3.00-6.4, p<0.001).

Discusion: More than two thousand of long term inpatients with non-mood psychotic disorders were discharged from Czech mental hospitals between 2006 and 2011; some of these patients had been hospitalized for more than 20 years. This might be at odds with the Article 19 of the Convention on the Rights of Persons with Disabilities which states that it is a human right to live independently and in the community.