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Cited by 73Psychiatric care and mental health servicesSchizophrenia research and treatmentHealthcare Decision-Making and Restraints

Systematic review of the effectiveness of planned short hospital stays for mental health care

Open access
Johnstone, P., Zolese, G.·1999·BMJ
DOI 10.1136/bmj.318.7195.1387PMC PMC27881
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Abstract

OBJECTIVE: To determine the effectiveness of planned short hospital stays versus standard care for people with serious mental illness. DESIGN: Systematic review of all randomised controlled trials comparing planned short hospital stay versus long hospital stay or standard care for people with serious mental illness. SUBJECTS: Four trials enrolled 628 patients. MAIN OUTCOMES MEASURES: Relapse; readmission; death (suicides and all causes); violent incidents (self, others, property); lost to follow up; premature discharge; delayed discharge; mental state (not improved); social functioning; patient satisfaction, quality of life, self esteem, and psychological wellbeing; family burden; imprisonment; employment status; independent living; total cost of care; and average length of hospital stay. RESULTS: Patients allocated to planned short hospital stays had no more readmissions (in four trials, odds ratio 0.93, 95% confidence interval 0.66 to 1.29 with no heterogeneity between trials), no more losses to follow up (in three trials of 404 patients, 1.09, 0.62 to 1.91 with no heterogeneity between trials), and more successful discharges on time (in three trials of 404 patients, 0.47, 0.27 to 0.85) than patients allocated long hospital stays or standard care. Some evidence showed that patients allocated planned short hospital stay were no more likely to leave hospital prematurely and had a greater chance of being employed than those allocated long hospital stay or standard care. Data on mental, social, and family outcomes could not be summated, and there were few or no data on patient satisfaction, deaths, violence, criminal behaviour, and costs. CONCLUSION: The effectiveness of care in mental hospitals is important to patients, carers, and policy makers. Despite inadequacies in the data, this review suggests that planned short hospital stays do not encourage a "revolving door" pattern of care for people with serious mental illness and may be more effective than standard care. Further pragmatic trials are needed on the most effective organisation and delivery of care in mental hospitals.

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  • Some studies indicate that a shorter length of stay is as effective as a longer length of stay (e.g., 30 days) in reducing symptoms of dementia, major depression, and schizophrenia.

    “Although some studies indicate that shorter LOS is as effective as longer LOS (e.g., 30 days) in reducing symptoms of dementia (Kunik et al., 2001), major depression (Pettit et al., 2005), and schizophrenia (Johnstone and Zolese, 1999)”

    From Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment (2020) · cites this paper as Johnstone and Zolese, 1999

    The trial description identifies a schizophrenia study comparing a planned 21–28-day stay with a 90–120-day standard stay. The outcomes section reports no difference between groups in the percentage of patients ‘not improved,’ which supports the qualified comparison. It does not establish equal reductions in schizophrenia symptoms, and 30 days was not the longer stay in that trial. The dementia and major-depression citations are separate from the citation to Johnstone and Zolese. (LLM, conf=0.84)

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Research works printed but not linked: 24

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Authors
Johnstone, P., & Zolese, G.
Corresponding author
Johnstone, P.
Venue
BMJ
Publisher
BMJ
Published
1999-05-22
Volume
318
Issue
7195
Pages
1387-1390
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.318.7195.1387
PMC
PMC27881
OpenAlex
W2143162427
Cited by
73
References
0
Citations by year
2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 7 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 7
FWCI
0.89
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
Keywords
severe mental illness, psychiatric inpatient care, length of hospital stay, hospital readmission, premature discharge, employment effects, social functioning, family burden, cost of care, patient satisfaction
MeSH terms
Activities of Daily Living, Mental Disorders, Employment, United Kingdom, Hospitals, Psychiatric, Humans, Length of Stay, Patient Care Planning, Psychiatric Department, Hospital, Randomized Controlled Trials as Topic, Health Care Costs, Outcome Assessment, Health Care

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