Impact of completing a psychosocial rehabilitation programme on inpatient service utilisation in South Africa

Abstract

Background: Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions. Aim: To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors. Setting: New Beginnings transitional care facility in South Africa. Methods: A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed. Results: Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p 0.001) DIH postindex in comparison to pre-index admission. Conclusions: This study’s findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness. Contribution: This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.

Keywords

• deinstitutionalisation
• psychosocial rehabilitation
• transitional care
• mental illness
• days-in-hospital.