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7.8 Days Are Not Enough

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If ever there was an illustration of what’s wrong with “ultra-short” psychiatric hospital stays, it’s the story of Adam Knapp.

hospital-staysKnapp died 18 days – and three hospital admissions – after he slit his wrists and swallowed two bottles of pills in a suicide attempt. He was killed when five cars struck him after he made a U-turn on a Washington state highway, collided with an oncoming car whose driver later died of injuries and leapt from his vehicle into traffic.

“You killed my son,” his mother Marcia Knapp told a nurse who answered the telephone at Ohio State University Medical Center, the third of the hospitals that admitted and released him in the days before the deadly episode, according to a detailed account of Adam Knapp’s final weeks (“Son who hears voices finds health care fatally dysfunctional,” Tom Moroney, Bloomberg News, Feb. 28).

The Bloomberg story cited data showing that the average hospital stay for acute psychiatric care has dropped almost 50% in barely 15 years – from 12.8 days in 1993 to 7.8 days in 2009.

As anyone who lives or works with severe mental illness knows, that’s not long enough for medication to reach a therapeutic level so that voices cease, delusions retreat, paranoia fades. Twenty psychiatric experts interviewed for the story said the rate of relapse and incidences of violence and death are rising as a result of shorter hospital stays.

In the face of such data and tragic stories such as Knapp’s, you’d think public officials would widely embrace assisted outpatient treatment (AOT). At least with AOT in place, there would be some mechanism in place to further the stabilization of patients released from hospitals so fast that treatment isn't in full effect.

In far too many places, you’d think wrong.

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