News

Hospital stays for psychiatric patients have fallen sharply in recent years, suggesting that people with mental-health problems are being discharged quicker and sicker than ever before, a trend that alarms physicians and consumer advocates.

A report released yesterday by the Canadian Institute for Health Information showed there are fewer mental-health patients admitted to hospital per capita than five years ago. For those who do seek treatment, the average stay has plummeted 55 per cent, to 16 days in 2005-06 from 36 days in 2000-01.

While the report did not include data to indicate levels of patient health at the time of release, it did reflect significant changes in the treatment of mental disorders, which have largely shifted from the realm of psychiatric-specific care facilities, where the most common length of stay is 26 days, to general hospitals, where the most common stay lasts eight days.

"If people don't understand what's behind the numbers, they'll think this is a good-news story. That worries me," said Phil Upshall, national executive director of the Mood Disorders Society of Canada.

Patrick White, president of the Canadian Psychiatric Association, said the drop in patients' length of stay reflects overall "pressure on the system." Because of hospital bed shortages - or inefficient use of beds allocated for psychiatric care - patients are being discharged more quickly even though they are sicker and more unstable than in the past, he said.

While 16 days may seem like a long time to spend in hospital, Dr. White, who runs the psychosocial, vocational and behavioural unit at Alberta Hospital in Edmonton, said for a patient with chronic schizophrenia who suffers a relapse, it is much too short.

"It should probably be a least 30 days, but there is pressure to free up the bed for someone else," he said.

Mental-health patients typically lose out to patients with physical illnesses in bed-shortage scenarios, Mr. Upshall said.

"Hospitals and hospital administrators have traditionally discriminated against mental-health conditions and people with them. That's principally because of, in my view, the stigma attached to mental illnesses," he said.

"They're discharging people into the community without the necessary supports. You would never discharge a patient with a broken back in need of a wheelchair without a wheelchair."

Dr. White said the decreases in hospital stays might be partly attributable to advances in medication used to treat psychiatric illnesses, which are now more effective and have fewer side effects, so patients have fewer relapses that require hospitalization.

According to the report, hospital readmission rates varied across the country, with the lowest being in Manitoba and Saskatchewan, and the highest in Prince Edward Island and British Columbia.

It also found that nearly 20 per cent of people discharged from hospital suffer some form of mental illness. Mood disorders such as depression and bipolar disorder made up the greatest proportion of mental-illness hospital admissions in every province. In the Northwest Territories and Yukon, substance-related disorders were the most common diagnoses.

David Goldbloom, vice-chair of the Mental Health Commission of Canada, a professor of psychiatry at the University of Toronto and the senior medical adviser of education and public affairs at the Centre for Addiction and Mental Health, said there is not enough patient-specific information in the report to speculate on what is driving the trends.

"What you can say on an optimistic level is maybe there are more resources in the community to provide care for people," Dr. Goldbloom said, adding: "All of this is a bit moot in the absence of crucial information on how people are doing."