Released, Relapsed, Rehospitalized: Length of Stay and Readmission Rates in State Hospitals, A Comparitive State Survey

After a half-century of eliminating beds for patients with severe mental illness, the United States is in the midst of an unparalleled
psychiatric bed shortage. Driven by the shortage, the length of stay (LOS) for those patients who are admitted has been shrinking for decades, and rehospitalization rates have been rising. For Released, Relapsed, Rehospitalized, Treatment Advocacy Center analyzed state data reported to the federal government to assess whether an association exists between shorter LOS in state hospitals and higher rates of readmission at 30 and 180 days following discharge. The study’s findings suggest that discharging patients “quicker but sicker” may have the unintended consequence of fueling revolving-door hospitalization, a pattern that disrupts mental health recovery and increases treatment costs.

Top Takeaway
States with shorter median psychiatric hospital stays have significantly higher readmission rates than states with longer median stays, both at 30 days and at 180 days. Given the human and economic toll of relapse and rehospitalization, the role of short hospital stays
in psychiatric rehospitalization merits systematic analysis to suggest policies and practices.

Fast Fact
Psychiatric patients in states with the shortest LOS were nearly three times more likely to be readmitted within 30 days or 180 days of discharge than patients in states with the longest LOS.

Behind the Facts

• In 1955, the peak of state hospitalization, there were 560,000 beds available for an estimated 3.3 million American adults living with serious mental illness and other disabilities. By early 2016, after more than half a century of deinstitutionalization, there were slightly fewer than 38,000 beds for 8.1 million people with the same conditions.
• Psychiatric hospitalization is the single greatest direct cost of serious mental illness. In 2013, schizophrenia hospitalization alone cost the United States $11.5 billion, of which $646 million resulted from readmission within 30 days of discharge.
• Releasing patients faster creates more bed capacity without requiring new beds. Under the influence of widespread psychiatric bed shortages and pressure to reduce hospitalization costs, length of stay has been shrinking for decades. In 1980, the median LOS for an acute episode of schizophrenia was 42 days. By 2013, it was about 7 days.
• More people are competing for an ever smaller number of inpatient psychiatric beds, where they stay ever shorter periods of time, after which they are more likely to be readmitted to the same hospital within weeks to six months of discharge.