Characteristics of patients with recurrent involuntary admissions for seventy-two hour assessment at Kimberley Hospital Complex, Northern Cape Province, Republic of South Africa
Introduction: Mental illness is common throughout the world, yet the true prevalence is underestimated. Forty-three percent (43%) of all psychiatric admissions in South Africa are involuntary, with a cyclical rise in re-admission rates, referred to as the revolving door syndrome. There was a need to unravel this syndrome, and help identify early, those patients at high risk of it, so that appropriate interventions are implemented to optimise psychiatric care and stem this system failure. Aim: The study aimed to quantify the frequency of re-admissions and recurrent re-admissions and describe the demographic characteristics, social support systems, and clinical characteristics of patients admitted for involuntary seventy-two-hour observation at the Kimberley Hospital Complex, Department of Family Medicine in the Northern Cape Province of South Africa. Method: This was a retrospective, hospital records- based cohort study, of all qualifying 1142 consecutive, involuntary admission episodes, from 614 patients at Kimberley Hospital from 01 January 2016 to 31 December 2017. There was a purposeful, non-random participant selection. Results: Fifty-four percent of the participants were admitted only once during the study period (n=614; 54%). The recurrent re-admission rate was two percent (n=28; 2%), with an average 6 admissions per each participant in the recurrent readmissions group, and the admissions ranging from five to sixteen (range 5 - 16). In between, the re-admissions decreased from a low risk rate of 32% (n=365) to high risk rate of 12% (n=135). Conclusion: This study showed that recurrent re-admissions, also known as the revolving door syndrome, is as much a problem in the Northern Cape Province of South Africa as it is across the rest of the world. The participant at a high risk of re-admission was more likely to be male, Black, young, unemployed, single, abusing substances, coming from a low-income area, with a previous history of involuntary admission, with a diagnosis of Schizophrenia and/or substance-use psychiatric disorder, be on antipsychotic medication, and with a long in hospital stay. Being of Coloured ethnicity, was a particular risk factor for recurrent re-admissions.