Email updates

Keep up to date with the latest news and content from BMC Psychiatry and BioMed Central.

Open Access Highly Accessed Research article

Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

Alex D Tulloch1*, Mizanur R Khondoker12, Paul Fearon13 and Anthony S David1

Author Affiliations

1 King’s College London, King’s Health Partners, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK

2 NIHR Specialist Biomedical Centre for Mental Health, Maudsley Hospital, London, SE5 8AZ, UK

3 Trinity College Dublin and St Patrick’s University Hospital Dublin, James’s Street, Dublin 8, Eire

For all author emails, please log on.

BMC Psychiatry 2012, 12:121  doi:10.1186/1471-244X-12-121

Published: 21 August 2012

Abstract

Background

A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures.

Methods

Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression.

Results

Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor.

Conclusions

Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.

Keywords:
Length of stay; Hospitals psychiatric; Mental disorders; Residential mobility; Homeless persons