Delay in discharge of psychiatric patients frequently is attributed to the lack of available community resources, or to the unwillingness of the patient or his family to accept discharge or transfer to another facility. The role of the psychiatric system itself rarely is mentioned as a factor. A study of 138 psychiatric patients in a Canadian community hospital in 1978 showed that 35 per cent were judged to be delayed in their discharge. By far the greatest source of delay was the administration of the various psychiatric services within the system. Delayed patients were found to be statistically similar to nondelayed patients, except for the delayed patients tendency to be poorer and to be overrepresented on two of the six wards studied. The cost implications of the delays in discharge are discussed, as are suggestions for solving the problems within the administrative framework.
Psychiatric morbidity, expressed as hospital admissions during a 30-year follow-up period, was studied among 322 former child psychiatric patients, who were admitted from 1949-1951, and who were followed up as of December 31, 1980. A total of 115 patients (36%)--55 boys (29%) and 60 girls (45%)--had been admitted to an adult psychiatric department, with 50 patients having only one admission. The mean age at the time of the study was 39 years. The former child psychiatric patients were admitted to adult psychiatric hospitals 50 times more often than comparable age groups from the general population. At all times women had a higher prevalence of admission. The cumulative percentage of first admissions of men was almost unchanged during the last 10 years of the follow-up period, and the figure for women was gradually increasing. The longitudinal course of mental disorders in the sample, measured as psychiatric admissions, was studied in relation to age at the time of admission to the child psychiatric department. The results consistently showed that older age of admission as a child meant fewer psychiatric admissions as an adult during the follow-up period. A total of 39 of the psychiatrically admitted patients (34%) had been granted a disability pension. A total of 7 patients (6%) died during the study period, including 2 patients who committed suicide. By the variables employed, 37% of the sample were judged to have had a good overall outcome, with diagnosis being an inconsistent predictor of outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of the investigation was to examine the utilization of the Danish legislation concerning access to case records by means of a prospective registration and questionnaire. During the investigation-period (1.3.1987-29.02.1988) 50 requests were made of which only one was refused for a limited period. The patients requesting to read their records differed from the total population of hospitalized patients as regards diagnosis as significantly more schizofrenic and fewer patients with diagnoses of drug abuse, were found. One of the 32 patients who actually read their records became more psychotic afterwards and two patients stated that they had become agitated. However, 15 patients felt calmer and 29 patients (90.6%) stated that the purpose of requesting access to their records had been fulfilled. The overall impression is that the law, which came into effect 1.1.1987, has functioned adequately although a more restrictive attitude would perhaps have reduced the negative influence on the psychotic conditions observed in three patients.
During 1987, all requests for access to case records at the Psychiatric Hospital in Vordingborg were registered prospectively. Fifty-nine patients made a total of 69 requests for access to case records. The total time used by the staff in connection with the requests was 51 hours and 47 minutes. Of all the patients admitted to the hospital in 1987 only 3.7% asked for access to case records. No serious problems in relation to this were registered. There was a significant tendency for the younger patients, the patients with non-psychotic disorders, and especially patients with borderline disorders to ask for access to their records more frequently.