More Than One In Three Patients Hospitalized For Mental Illness Are Readmitted Within One Year Of Their discharge

Over one in three patients (37%) discharged from a general hospital with a diagnosis of mental illness were readmitted within one year of their discharge, according to a new report released today by the Canadian Institute for Health Information (CIHI). In comparison, 27% of all other patients admitted to a general hospital were readmitted within a year. For the first time, CIHI's annual report Hospital Mental Health Services in Canada, 2003-2004 presents information on general hospital readmissions and their relationship to seven diagnosis categories of mental illness.


"Readmission for a mental illness is often linked to a disruption in outpatient treatment and rehabilitation and may signal instability or a recurrence of severe symptoms of a disease," says Nawaf Madi, CIHI's Program Lead for Mental Health and Addictions. "This is an area of concern for health planners, because, among other things, treating a patient in hospital is significantly more expensive than treatment at the outpatient or community level."


Risk of readmission linked to age, diagnosis


The risk of readmission to general hospital for an individual with a primary diagnosis of mental illness increases with the age of the patient, from a rate of 26.5 per 100 of those aged 0 to 14, to 38.7 per 100 of those aged 65 and over. Among the diagnosis categories, the risk of readmission was higher for individuals with a primary diagnosis of personality disorder (45%), followed by individuals with schizophrenia (41%). Readmissions were similar for women and men (38.3% and 35.5%, respectively) and, overall, the longer the initial general hospital stay, the greater the chance of readmission within one year.


Thirty percent of all general hospital days stayed in 2003-2004 involved a patient diagnosed with mental illness


Patients with a primary diagnosis of mental illness accounted for 6% of all hospitalizations in Canada; another 8% involved patients with a non-psychiatric primary diagnosis and an associated mental illness. But since lengths of stay for patients with mental illness were more than twice as long as for others, these hospitalizations combined accounted for 30% of the total number of days patients spent in Canadian general hospitals in 2003-2004. The average length of stay for a patient with a primary diagnosis of mental illness in a general hospital was 16.9 days in 2003-2004, compared to 7.2 days for those with a non-psychiatric diagnosis.


Schizophrenia accounted for the longest average length of stay (60 days), while mood disorders (depression and bipolar disorder) accounted for the largest proportion (32%) of hospitalizations for mental illness.















Number of patients using general and psychiatric hospital mental health services declining over time


Although the number of psychiatric patients hospitalized in Canada in 2003-2004 was similar to the number reported in 2002-2003, over the last ten years there has been a decline in both the number of patients using general and psychiatric hospital mental health services and in their average length of stay. For 2003-2004, the average length of stay was 35 days; this represents a 47% decrease from 66 days in 1994-1995. Conditions such as depression and bipolar disorder were the most common diagnoses for mental health hospitalizations in 11 of 12 provinces and territories (the exception is the Northwest Territories, where substance-related disorders were most common).


The vast majority (86%) of patients hospitalized because of mental illness in 2003-2004 were cared for in general hospitals, rather than in psychiatric hospitals. Patients with schizophrenia, generally considered the most severe mental health condition, were more likely than any other group to have received treatment from a psychiatric hospital, rather than a general hospital.


One in five patients hospitalized for mental illness also had a substance-related disorder


In 2003-2004, 20% of patients hospitalized in general hospitals with a primary diagnosis of mental illness also had a substance-related disorder (for example, alcoholism). On average, these patients were younger than those without substance-related disorders and they were more likely to be male. Patients hospitalized with personality disorders made up almost one third (27.6%) of those psychiatric patients with a co-occurring substance-related disorder.


About CIHI


The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.


The report and the following figures and tables are available from CIHI's website at cihi.ca.


Table 1.
Risk of One-Year Readmission per 100 Persons, 2003-2004 (adapted from Table 3.1 in the report)

Table 2.
Characteristics of the Population, 2003-2004 (adapted from Table 1.2 in the report)

Figure 1.
Hospital Separation Rate for Mental Illness by Type of Hospital, 1994-1995 to 2003-2004 (Figure i in the report)

Figure 2.
Average Length of Stay for Mental Illness by Type of Hospital, 1994-1995 to 2003-2004 (Figure ii in the report)

Figure 3.
Percentages of Separations by Diagnosis Category for General Hospitals, 2003-2004 (Figure 1.1 in the report)

Figure 4.
Percentages of Separations by Diagnosis Category for Psychiatric Hospitals, 2003-2004 (Figure 1.2 in the report)