One-fifth of the patients released from psychiatric hospitals in Israel end up readmitted within 30 days of their release, and at some hospitals, the readmission rate within a month is 25 percent, according to a new Health Ministry quality indicators report.
The figures demonstrate the inadequacy in treating and rehabilitating the mentally ill during the critical period after their release from the hospital. The data indicate a lack of supportive care or residential settings in the community and of programs providing a transition between hospitalization and ongoing care at local clinics that are generally not equipped to handle patients who have been in a psychiatric ward.
The absence of appropriate settings for former psychiatric patients, which professionals have been complaining about for years, is also highlighted in another indicator from the report. While 85 percent of those released have a follow-up appointment made for them at a community clinic – which is even better than the target for such appointments – simply making an appointment at an HMO clinic does not assure continuity of care.
As the report itself states, “the transition from hospitalization back into the community can involve adjustment difficulties and crises that undermine the continuity of care and the rehabilitation of patients. Studies done on the subject show that between 33 percent and 65 percent of patients never come for follow-up at a community clinic.”
As a result, most of those released from the hospital – some after a lengthy period of hospitalization – find themselves in poor health. Among those without a supportive family, they can find themselves in problematic circumstances soon after their release. According to the report, in 2016 only 36 percent saw a doctor within a week of their release. And twenty percent of released patients suffered from serious problems relating to their medications, some of them life-threatening.
Differences between psychiatric and general hospitals
The report also showed significant differences in the rate of readmission within a month depending upon the psychiatric facility at which patients were treated. There were also significant differences between psychiatric hospitals and psychiatric wards in general hospitals, where the rate of rapid readmission was far lower, averaging 11 percent, compared to the 21 percent at psychiatric hospitals.
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The psychiatric hospitals with the highest readmission rates were Abarbanel (25 percent); Lev Hasharon (25 percent); Shalvata (24 percent); Sha’ar Menashe (23 percent); Be’er Sheva Mental Health Center (23 percent); Be’er Yaakov Mental Health Center; and Mazor (20 percent). The hospitals with the lowest readmission rates were Geha (12 percent) and the Jerusalem Mental Health Center (14 percent).
As noted, psychiatric wards at general hospitals tended to have lower readmission rates – just 2 percent at the Scottish Hospital, 6 percent at Rambam Medical Center and 7 percent at Western Galilee Hospital and Ma’ayanei Hayeshua in Bnei Brak. At two other general hospitals, Barzilai Medical Center and Sheba Medical Center, it was 15 percent and Ichilov, it was 19 percent.
The disparities in the rates between the psychiatric hospitals and the general hospitals don’t necessarily indicate deficiencies in the quality of care. The assumption is that at least some of the differences stem from the fact that most general hospitals don’t have closed psychiatric wards, making their patient profile different. Other disparities can be found between hospitals that have special departments for eating disorders and those that don’t; the latter have more frequent readmissions.
According to data presented last November in connection with the national plan for community medicine quality indicators of the Israel National Institute for Health Policy Research, only 35 percent of those who suffer from serious mental illnesses visit a mental health clinic at the required intervals after being released from a psychiatric hospital.
Lack of care for physical ailments
It was also reported that the population of those released following hospital psychiatric treatment, some 74,000 people, are left without treatment for their physical problems. An examination of their medical files showed that only 58 percent of those with serious mental illness had basic information such as height and weight noted in their records, compared with 90 percent of the general population.
It also emerged that among those patients who had been weighed, 38 percent were overweight, compared to 23 percent of the general population. Fourteen percent of the psychiatric patients had diabetes, compared to 9.6 percent of the general population, but when it came to the treatment of diabetes, the quality of treatment as measured through testing and stabilizing their diabetic condition was identical among the two groups.