Long-term hospitalized female patients in a psychiatric hospital and their discharge

Czech version

Authors: Krystynová Tereza
Authors‘ workplace: Priessnitzovy léčebné lázně, Jeseník
Published in: Čes. a slov. Psychiat., 121, 2025, No. 1, pp. 29-37.
Category: Original Article
doi: https://doi.org/10.48095/cccsp202503

Overview

Introduction: Since 2013, the reform of psychiatric care has been underway in the Czech Republic, a part of which is the process of deinstitutionalization. Thanks to system changes, the number of long-term hospitalized patients has decreased. However, two thousand patients stay in psychiatric hospitals in the Czech Republic for more than six months. The study is on what structured rehabilitation programs should look like in long-term psychiatric care. Deinstitutionalization not only has the potential to reduce costs long-term, but also to improve the quality of life of patients. Objectives: The aim of this work was to conduct a prospective investigation at the level of one female aftercare ward of a regional psychiatric hospital, which was to answer the following questions: What were the basic sociodemographic and clinical characteristics of the female patients hospitalized in this department for more than 6 months? How many of them were released within 7 months and where? Methods: Female patients whose stay as of May 31, 2023 was longer than 182 days were included in the study. Interruption of hospitalization for less than 21 days was not considered as termination of hospitalization. Data were obtained from the hospital information system. Monitored parameters included length of hospitalization, age, education, marital status, number of children, nationality, residence, basic diagnosis, somatic comorbidities, capability to manage their own affairs, guardian, institutional protective treatment, disability, previous living arrangements, number of applications submitted to residential social services, and how many applications were approved, denied, or pending. From June 1, 2023 to December 31, 2023, it was continuously recorded which patients from the above cohort were discharged and to which facilities. Statistical data processing included basic descriptive analysis, qualitative analysis of cases with the longest hospitalization time, and the Mann-Whitney U test to compare age, education level, and length of hospitalization between discharged and non-discharged patients. Results: Thirty female patients met the criteria and were included in the follow-up. Most of the long-term hospitalized patients had a chronic psychotic illness, primary education, were unmarried, without children, of Czech nationality, from the Moravian-Silesian region, limited in their autonomy, disabled, and without a functioning family background. By the end of 2023, 13 or more precisely 11 out of 25 patients (44%) were discharged due to separate listing of patients with protective treatment. Compared to those that were not discharged, discharged women were hospitalized for a shorter period of time. Intensive psychosocial rehabilitation and opening of a new DOZP (Home for People with Disabilities) in the region contributed to the discharge. Conclusion: The study shows that with systematic work with the use of individual psychosocial rehabilitation, sufficient staffing and the available capacity of social services, it is possible to discharge long-term hospitalized patients with a serious mental illness from the psychiatric hospital. However, this is a complex and lengthy process requiring the involvement of a multidisciplinary team equipped with key competencies. The transition process needs to be carefully planned.

Keywords:

deinstitutionalization – long-term hospitalization – psychiatric hospital – reform of psychiatric care – psychosocial rehabilitation – serious mental illness

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MUDr. Tereza Krystynová

Priessnitzovy léčebné lázně a. s.

Priessnitzova 299

790 01 Jeseník

e-mail: krystynova3@centrum.cz