School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles.
Psychiatr Serv. 2022 Jun;73(6):613-619. doi: 10.1176/appi.ps.202100254. Epub 2021 Oct 27.
The purpose of this study was to examine associations between homelessness and length of psychiatric hospitalization and to explore the role of mental health conservatorship in determining discharge location for patients who are homeless and have a grave disability from serious mental illness.
This observational study used administrative data from a safety-net psychiatric hospital in Los Angeles. The sample included 795 adults (≥18 years) who were hospitalized on an involuntary psychiatric hold between 2016 and 2018. The outcome variables were length of stay (days) and discharge location (home, locked psychiatric facility, unlocked psychiatric facility, unhoused). The predictor variables were homelessness status and whether a mental health conservatorship was initiated during hospitalization. Multiple regression models were used to estimate associations between variables.
Homelessness status was associated with 27.5 additional days (SE=3.5 days) of hospitalization in adjusted models. Homeless patients for whom conservatorship was initiated comprised 6% of the sample but 41% of total inpatient days. Among people who were homeless, initiation of a conservatorship was associated with significantly longer length of inpatient stay (mean=154.8 days versus 25.6 days for the whole sample) but also with lower odds of being unhoused at the time of discharge (risk ratio=0.19, 95% confidence interval=0.09-0.34).
A mental health conservatorship can be a mechanism for helping homeless people with a grave disability from mental illness to transition from the streets to residential psychiatric treatment, but it requires substantial resources from facilities that initiate such conservatorships and does not guarantee resolution of long-term supportive housing needs.
本研究旨在探讨无家可归与精神科住院时间的关系，并探讨精神健康监护权在确定患有严重精神疾病且严重残疾的无家可归患者出院地点方面的作用。
本观察性研究使用了洛杉矶一家保障性精神病院的行政数据。样本包括 795 名（≥18 岁）在 2016 年至 2018 年期间因非自愿精神科留院的成年人。因变量为住院时间（天）和出院地点（家、上锁精神科设施、未上锁精神科设施、无家可归）。预测变量为无家可归状况和住院期间是否启动精神健康监护权。采用多元回归模型估计变量之间的关联。
在调整后的模型中，无家可归状况与住院时间增加 27.5 天（SE=3.5 天）相关。在接受监护权的无家可归患者中，占总样本的 6%，但占总住院天数的 41%。在无家可归者中，启动监护权与住院时间显著延长相关（均值=154.8 天，而整个样本为 25.6 天），但也与出院时无家可归的可能性降低相关（风险比=0.19，95%置信区间=0.09-0.34）。
精神健康监护权可以作为帮助患有严重精神疾病且严重残疾的无家可归者从街头过渡到住院精神科治疗的一种机制，但它需要启动此类监护权的机构提供大量资源，并且不能保证解决长期的住房需求。
