Suzuki Kosuke, Niitsu Tomihisa, Kimura Hiroshi, Yanagisawa Yuta, Ono Marina, Komatsu Hideki, Yoshimura Kensuke, Watanabe Hiroyuki, Iyo Masaomi
Department of Psychiatry Chiba University Graduate School of Medicine Chiba Japan.
Department of Psychiatry Gakuji-kai Kimura Hospital Chiba Japan.
PCN Rep. 2024 Apr 1;3(2):e189. doi: 10.1002/pcn5.189. eCollection 2024 Jun.
The mental healthcare system in Japan is transitioning from institution-based to community-based treatment. To prevent prolonged hospitalization and community integration of psychiatric patients, mental health social workers (MHSWs) are pivotal in coordinating post-discharge arrangements for psychiatric inpatients. This study aimed to propose a care model to improve clinical outcomes in psychiatric emergency wards in Japan.
We conducted a mail-in questionnaire survey targeting medical facilities with psychiatric emergency wards. We collected data of the psychiatric care system, including facility profiles, staffing conditions and caseloads, and the provided psychiatric services and treatment options. Using multiple regression analyses, we explored associations between these data and clinical outcomes, focusing on the average number of days for hospitalization and the integration of patients into a community.
Data were collected from 82 facilities (response rate, 45.8%). The average number of days for hospitalization and community integration were 64.7 and 327.9 days, respectively. The caseloads for MHSWs were significantly associated with longer hospitalization ( = 0.31, = 0.009) and shorter duration of community living ( = -0.28, = 0.027).
The clinical performance in psychiatric emergency wards surpassed the Japanese government's targets regarding these outcomes. We found that heavy caseloads on MHSWs were associated with worse clinical outcomes for patients in psychiatric emergency wards. These findings suggest that reducing MHSW caseloads (≤20 cases) may be a potential interventional strategy to prevent prolonged hospitalization and promote successful community integration of patients.
日本的精神卫生保健系统正在从基于机构的治疗向基于社区的治疗转变。为防止精神病患者长期住院并促进其融入社区，精神卫生社会工作者（MHSWs）在协调精神病住院患者出院后的安排方面起着关键作用。本研究旨在提出一种护理模式，以改善日本精神科急诊病房的临床结局。
我们针对设有精神科急诊病房的医疗机构开展了一项邮寄问卷调查。我们收集了精神科护理系统的数据，包括机构概况、人员配备情况和工作量，以及所提供的精神科服务和治疗选择。通过多元回归分析，我们探讨了这些数据与临床结局之间的关联，重点关注住院天数和患者融入社区的情况。
从82家机构收集了数据（回复率为45.8%）。住院天数和融入社区的天数平均分别为64.7天和327.9天。MHSWs的工作量与更长的住院时间（β = 0.31，P = 0.009）和更短的社区生活时长（β = -0.28，P = 0.027）显著相关。
精神科急诊病房的临床表现超过了日本政府在这些结局方面的目标。我们发现，MHSWs的高工作量与精神科急诊病房患者更差的临床结局相关。这些发现表明，减少MHSWs的工作量（≤20例）可能是预防长期住院并促进患者成功融入社区的一种潜在干预策略。
