There's a lot of it about

More evidence in the last week of the prevalence of mental health problems in general hospitals. This time it’s a report from the Agency for Healthcare Research and Quality (AHRQ) in the USA who describe hospital care for adults age 18 and older with mental health or substance abuse problems who were treated for those conditions in community (as opposed to speciality) hospitals in 2004. These are the most numerous hospitals in the USA (about 5000 institutions) – they are non Federal general hospitals but exclude speciality psychiatric or substance abuse treatment facilities.

A number of interesting facts and figures.

• Most psychiatric care occurs in the general hospitals, that is 44 million days of care to patients with mental health and substance abuse disorders compared to 27 million days of care in psychiatric facilities.

• Hospital stays for adults with only secondary MHSA diagnoses* were 20 percent longer than adults with no MHSA diagnosis (5.4 versus 4.5 days).

• Adults with only secondary MHSA diagnoses were the most likely to be admitted through the ED (63.6 percent). They were 1.4 times more likely to be admitted through the ED than those with no MHSA diagnosis (45.0 percent) and 1.3 times more likely than those with only a principal MHSA diagnosis (50.7 percent).

• The costs of stays with only secondary MHSA diagnoses were slightly less than stays with no MHSA diagnosis ($8,500 versus $8,900).

• Care for adults with only secondary MHSA diagnoses accounted for roughly 18 percent of hospital stays and total hospital costs and 20 percent of all days in the hospital.

• The top four secondary diagnoses were mood disorders, substance abuse disorders, schizophrenia and other psychoses (surprisingly) and delirium. No mention of somatoform disorders.

*Secondary MHSA disorders are people diagnosed with a principle non mental health diagnosis (for example myocardial infarction) but also have a secondary mental health diagnosis.

So to summarise about 1:6 admissions to community hospitals in the USA also have a mental health disorder, which costs slightly less to treat than those without a mental health disorder but they have a 20% longer admission. Presumably they don’t have increased costs because the increased length of stay is due to placement issues? The reassuring thing is that this confirms previous work that about 1:5 people admitted to hospital also have a mental health or substance abuse problem – there’s a lot of it about.