August 2, 2000
Release No. 00-36
Kimberly Cordero
202/682-6394
[email protected]
Re-hospitalizations, Healthcare Costs Reduced with Use of Personal Patient Advocates for Involuntary Psychiatric Patients
Washington, DC -- A new study shows that psychiatric patients are less likely to be re-hospitalized involuntarily if they are represented by a personal patient advocate throughout the entire duration of their original involuntary hospital stay -- translating to a significant reduction in overall healthcare costs.
Lead author Stephen Rosenman, M.D., of the Centre for Mental Health Research, Australian National University (Canberra), said the study provides a model of advocacy that could be effectively applied to involuntary psychiatric patients in the United States. "I do not think the issues addressed are, in any way, peculiar to Australia," he said. The study is published in the August 2000 Psychiatric Services.
Of the 105 involuntarily hospitalized psychiatric inpatients studied, 53 were represented by a personal advocate throughout the entire 25- to 29-day (approximate) period of involuntary treatment. Their outcomes were compared with those of 52 patients in a control group who only received routine advocacy at the point of hospital admission. Both groups shared similar demographic traits, diagnosis, and severity of illness.
During the seven-month follow-up period, 12 of the 53 who had been represented by a personal advocate (23 percent) were involuntarily re-hospitalized, compared with 23 of the 52 control subjects (44 percent) who had received only routine advocacy. During the follow-up period, the re-hospitalized control subjects spent 250 more days in the hospital at a cost of $150,000 (Australian).
The advocate was responsible for the patients' best interest -- not that of the public, state or hospital -- and acted as an objective, non-family liaison between the patient and the treating clinicians to negotiate treatment.
"Unlike voluntary patients, who are generally free and able to speak out, involuntary patients are often silenced by their illness and their status," note the study authors.
"Patients feel unfairly coerced when they believe that their interests have been ignored."
The authors suggest that the reduced rates of re-hospitalization were due, in part, to the fact that the personal advocate provided involuntary patients with a sense of inclusion in their own treatment decisions -- leading to increased satisfaction with their hospital experience and increased cooperation with aftercare.
"The personal advocate became a companion through an alien and frightening experience of illness and institutional treatment."
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