Inability to do daily living tasks delays discharge of mental health patients

Mental health patients who have difficulty performing daily living tasks are four times more likely to experience discharge delays than someone who can perform those tasks independently.

In a recent study, researchers from the University of Waterloo found patients who had not been able to maintain or learn skills such as taking medication, preparing meals, or arranging transportation experienced discharge delays of more than 30 days.

"We found that impairment in functional, social or cognitive abilities often means that patients experience a delay in being discharged, suggesting their needs are not being served in the mental health care setting," said Jerrica Little, lead author of the study and PhD candidate at Waterloo's School of Public Health.

"These facilities don't usually provide rehabilitation interventions for social engagement and life skills training, so providing these services - and coordinating with community partners at the time of admission - could be key to reducing the rate of delayed discharges."

Other factors resulting in delayed discharges included moderate-to-severe cognitive impairment (almost twice as likely), middle and older age (2-3 times as likely), and being male or speaking a non-official language (1.4 times more likely).

"Delays in discharge can reduce the flow through the hospital and restrict access to mental health beds for persons with more acute needs," said co-author John Hirdes, professor in Waterloo's School of Public Health and Health Systems. "However, it also can have negative consequences that make it more difficult for those patients to return to the community. For that reason, we regard improvements in these functional indicators to be important markers of the quality of in-patient mental health care."

According to the Ministry of Health and Long-Term Care, it costs an average of $930 per day to stay in one of Ontario's four specialty psychiatric hospitals.

The researchers obtained and examined data from the Resident Assessment Instrument-Mental Health (RAI-MH), a comprehensive standardized mental health assessment tool, at the request of the Ontario Hospital Association, which had noticed a high rate of delayed discharges. A total of 76,184 inpatient cases from 68 psychiatric facilities between 2011 and 2013 were examined, and researchers found delays of more than 30 days in 2,074 cases.