Israelis admitted to psychiatric hospitals have a heightened risk of death during and after their stays, a Health Ministry study shows. Neglect at these institutions increases the chance of death by suicide, disease, murder and road accidents.
The study, "Mortality Risk among Persons with Psychiatric Hospitalization," covered a period from the 1950s to 2006. It examined 136,687 patients; of these, 42,836 during a hospital stay or for a specific period thereafter.
The researchers concluded that such psychiatric patients' suicide risk is 16 times higher than that of the general population. According to the ministry, between 9 and 16 patients a year commit suicide in the country's psychiatric facilities.
The researchers say the psychiatric patients' risk of death by murder is 3.6 times higher than in the general population, and the risk of death in road accidents 2.6. times higher.
Patients in psychiatric hospitals also run a higher risk of death by disease - the risk is 2.4 times higher for respiratory ailments, 2.1 times for diabetes and 1.6 times for heart disease. But patients do not face an unusual risk of death due to cancer.
The study shows that the mortality risk due to disease is higher among psychiatric patients who were also drug or alcohol abusers. But the study did not find a direct link between the use of psychiatric medication and death by disease.
The researchers were headed by Ziona Haklai, director of the ministry's health information unit, and Dr. Itzhak Levav, a research consultant at the ministry's mental health branch.
Mortality rates as a result of disease during the past decade, after the transition to a new generation of medication, were similar to rates during the previous decade. Today, psychiatric hospitals lack a systematic framework for treating ailments such as heart disease or diabetes. The researchers recommend that Israel improve procedures for treating such diseases at psychiatric hospitals.
"Preemptive medical procedures, along with health education, should be administered soon after a patient is admitted to a psychiatric hospital," says Levav. "The family members of patients should be kept in the picture during the hospital stay, and doctors should be instructed to monitor patients' physical health after their release."
Such recommendations seem particularly pertinent due to the country's mental health reforms, particularly the transfer of authority for mental health treatment to the country's health maintenance organizations. Health Ministry officials say the reforms will be brought to the government for approval within a month.
The researchers referred to findings of a Danish study in 2000 that pointed to high rates of suicide among people treated in psychiatric institutions. This trend in Denmark was attributed to a reduction in the number of available beds for psychiatric patients.
The Health Ministry says that "among patients in prolonged psychiatric care there is a higher incidence of disease compared to the general population. This troubling reality is a global trend and is apparently linked to widespread causes such as the high number of cigarette smokers among psychiatric patients. An internist is employed at all psychiatric hospitals in Israel, and this specialist treats the patients' health problems."
The ministry adds: "We recognize the need to prevent disease, and about 18 months ago, the mental health branch sent a letter to residents of rehabilitation facilities. The letter featured recommendations about asking family physicians to examine sugar levels, blood pressure and cholesterol. There were also recommendations about diet and exercise."
Regarding the expected reform of the mental health system, the ministry says "it is important the patient remain in close contact with the family doctor. The reform should strengthen this connection and transfer responsibility for overall health to the HMOs."
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