An Improved System of Psychiatric Care for the Seriously Mentally Ill

The goal of this project was to uncover the factors associated with relapse and hospital readmission within the seriously mentally ill population (SMI). The purpose was to develop a proposal and recommendations for healthcare professionals and policy makers to reduce readmission rates following inpatient hospitalization. There is currently a high rate of hospital readmissions within the SMI population. High readmission rates are costly for the consumer, payer, and provider. Treatment success is largely dependent on medication adherence and on continuity of care. Failure to provide adequate and timely treatment is the most obvious cost to remediate. The objectives of this project were first to identify barriers to medication adherence for the SMI population by searching the literature. The second objective was to further identify barriers by conducting interviews with clinicians at local mental health facilities. The third objective was to develop a program of recommendations with the potential to reduce readmissions. Finally, the fourth objective was to present these findings back to those interviewed requesting feedback and disseminate to other mental health groups via a professional presentation. Based on the literature, there are a number of factors contributing to hospital readmission, and a major factor is medication nonadherence. The literature lacks suggestions or guidelines for inpatient and outpatient providers, on how to address the issue of continuity of care. Local inpatient and outpatient medical professionals provided their insight into the issues in caring for this population by participating in an interview. The providers contributed their perspectives on the issue based on their current workplace, inpatient or outpatient. This allowed for different perspectives contingent on treatment setting. The development of treatment guidelines included a synthesis of the information given from the interviews and information from the literature. The interviewed providers received the guidelines via email, and verbal follow-up. Feedback and further dissemination was encouraged. The guidelines included three themes: medication adherence promotion, improve provider communication, and adequate follow-up after hospitalization. In conclusion, this project provides needed guidelines and recommendations in order to reduce readmission rates for those with SMI. Providers and payers can use the findings of this project to improve the current system, and reduce destabilization and reduce readmission rates for the SMI population.