UTS 92638: Literature Review on Unplanned Readmission in Mental Health

This literature review examines the critical issue of unplanned readmission within the Australian mental health system. It explores the dynamics of community care, institutionalization, and deinstitutionalization, highlighting the differences between planned and unplanned admissions. The review analyzes various factors contributing to unplanned readmission, including lack of follow-up care, social determinants of health, and the impact of mental health disorders. It synthesizes findings from multiple studies, including those by Li et al., Zhou, and Duhig, Gunasekara & Patterson, to identify the implications of unplanned readmission on patient outcomes, healthcare costs, and resource allocation. The review emphasizes the need for improved assessment, intervention planning, and community-based services to reduce readmission rates and enhance patient well-being. The review also touches upon the challenges of providing adequate care, and offers insights into the social stigmas surrounding mental health diseases.

Running head: UNPLANNED READMISSION
UNPLANNED READMISSION
Name of Student
Name of University
Author note

1
UNPLANNED READMISSION
LITERATURE REVIEW
In the mental health system of Australia, community care is a very integral part of heath
servicing. Broadly, the mental health services in Australia are based on the type of settings,
the client or rather the subject is receiving the care. Institutionalization and
deinstitutionalization are the various service protocols through which the patient influx and
efflux are controlled in the Australian mental health system (Duhig, Gunasekara & Patterson
2017). The subjects who are mildly to moderately ill are delivered with the care services in
the community settings only thus helping them receive a cost effective care at the comfort of
their home and environment. But when a subject is severely ill due to severe mental health or
a neuropsychological condition, it is important to have him or her institutionalized as soon as
possible, in order to manage the symptoms without any further complications or
deteriorations (Ose et al., 2018). While it is absolutely critical to address the symptoms and
signs of the mental health disorder and condition in the hospital with a collaborative and
effective multidisciplinary team effort that would aid in faster recovery of the subject. It is
important to note that the faster recovery of the patient leads to more satisfaction in the
patient and his family and always an effective care means less chances of relapse of the
mental health condition or symptoms again that would prevent the chances of readmission
once. Planned admissions are situations when a person is aware of the symptoms or the
members of the family are cognizant of the gradually, anticipated deteriorating health
condition of the subject thus, helping the subject gets into an institution in a planned,
organized manner (Moore, Moonie & Anderson, 2019). More importantly, in a planned
admission of the patient in the mental health institution, the patient is voluntarily willing to
take the admission. But there are situations, very adverse of course, where the subject faces
an sudden, rapid and unexpected mental health signs and symptoms that are severe and has
uncontrollable episodes of precipitation and these are the situations where the family of the

2
UNPLANNED READMISSION
subject along with the subject himself is completely unprepared to think and address the exact
needs of the situation in a very planned manner. Hence, the subjects with sudden and severe
symptoms of mental health disorder are taken to the nearby hospital, which is followed by an
unplanned admission. Unplanned admission has various disadvantages such as lack of cost
ineffectiveness, lack of proper health care planning as the interventions has to be begun there
and then immediately, thus addressing the acute needs of the situation. Hence unplanned
admission of the patient to the mental health institution makes the situation complicated and
the consequent unplanned service delivery often lead to various complications with the
recovery process due to the possible lack of the quality of the care, being delivered. The
unplanned admission of the patient also increases the various aspects of other problems as
well such as more consumption of bed and care facilities, decrease in the bed availability to
the other patients, increase in the expenditure of the facility. When, the unplanned admissions
are not treated properly, the recovery rate is poor and at times, they have to be discharged to
prioritize the other planned admissions who are waiting in the queue. Discharge without
proper recovery of the subject leads to more issues with the hospital readmissions, that is not
only costly for the hospital but for the patient and his family as well. The number of
unplanned hospital admissions, are increasing in the Australian mental health system. And it
is very difficult to manage the situation.
Li et al., (2018) aimed to study ‘Emergency department presentation and readmission
after index psychiatric admission: a data linkage study’ and finds out important correlation
between the acute mental health treatment being undertaken in the hospitals of Australia and
the reason behind the readmission of the mental health subjects in the respective departments.
The researchers of the study performed a cohort study with the data sets that linked the
government level public health data regarding unplanned readmission of the psychiatric
patients (Kalseth et al., 2016).. The researchers of the study found out the rates and

3
UNPLANNED READMISSION
percentage of unplanned readmissions in the mental health care departments on the basis of
relapse time, after the index admission. In about 35, 056 individuals who were males and
were identified with index admission, 12826 were readmitted, unplanned back to the hospital
with a period of one to two years after discharge from the mental health facility. Of these,
fifty percent were readmitted unplanned in the psychiatry facility back in two to five months,
twenty eight per cent with zero to one month and 80 percent in six to twenty fours after
discharge from the hospital. While the treatment at the hospital was considered as the major
causes, there were also reasons such as lack of the follow up care, lack of the community care
that resulted in the re-institutionalization of the mental health subjects back to the facility.
There were various factors that were correlated in relation to the increased rate of unplanned
re-admissions of patient in the mental health care (Lawn et al., 2018). The factors such as
length of hospital stay during the first or the index admission, the types of the treatment
received, the kind of disciplines involved in the multidisciplinary process, the demographic
and the social factors involved with lifestyle of the subject, the level of care received at home,
social support and social interactions in relation to the patient, the comorbidity, drugs, alcohol
and other drugs as negative coping, lack of family support – were found be involved
immensely with the lack of personal recovery and complete remission, thus contributing to
the increased unplanned readmissions in the hospitals (Sharma et al., 2018).. The intellectual
disabilities, lack of proper inpatient service were greatly involved with the psychiatric
readmissions in the hospitals of Australia. The major findings were associated with the fact
that the recovery oriented practices are lacking in Australia, in most of the community as well
as the urban areas and the fact that the subjects or the client of the mental health services do
not recover completely from the various aspects of the diseases and disorder, they are more
likely to have a relapse of severe symptoms once again, leading to readmissions in the
psychiatric facilities. the researchers of the study finds out that disability is another major

4
UNPLANNED READMISSION
factor that leads to readmission of the patient and the lack of quality of mental health and
positive wellbeing services in the community health settings – that cause the readmission
rates, to increase drastically. The proper needs assessment and proper intervention planning at
the index planning is critical to reduce the rate.
Zhou aims to study (2019) and finds out ‘A 5-year retrospective cohort study of
unplanned readmissions in an Australian tertiary pediatric hospital’ and finds out various
critical factors involved in the process of readmissions of mental health subjects in the
impatient care. The factors that were responsible for the readmission of the pediatric children
at the hospital were deterioration of the mental health issues leading to the rapid decline of
the neurocognitive functions and decline of the normal functioning of daily life. Mostly the
conditions involving the neuropsychological conditions that were progressive and advancing
in nature affected the breathing, eating, sleeping behaviors in the children that contributed to
the increased rates of hospital readmissions due to presentation of severe emergency. The
aggressive and self-harm behaviors in the pediatric children were not managed properly in
the community settings by the educators, parents, community mental health workers, general
practitioners, community health nurses and the other mental health professionals that affected
the various types of the factors that were then involved with the sudden, unplanned
readmissions of the children at the mental health institutions and the other medical specialty
departments (Hariman et al., 2020). It is highly important to note that the child care and child
mental health services at the community level were greatly implicated in the caring process of
the children with behavioral, intellectual and other neuropsychological difficulties and lack of
there critical home based and community based services were greatly involved in the process
of the unplanned readmission of the mental health subjects. Parental lack of knowledge and
awareness about the level of impairment in the child and what exact interventions are

5
UNPLANNED READMISSION
required to facilitate the functioning of the child at the daily day to day manner are greatly
involved in the presentation of acute symptoms.
Duhig, Gunasekara & Patterson (2017) aimed to study ‘Understanding readmission to
psychiatric hospital in Australia from the service users’ perspective: a qualitative study’ and
finds out important correlation between the intrapersonal, internal and the various
sociocultural factors that are involved with the process of unplanned readmission of the
psychiatric patients back to the hospitals after their discharge and this happened mostly
within one year (Looi & Kisely 2018). It is important to note that as per the researchers of the
study, the environmental factors are greatly implicated in the development of chances that
lead to presentation of acute symptoms in the psychiatric subjects that lead to the readmission
of the subjects into the hospitals, after the discharge. The social determinants of health such
as lack of knowledge about the disease, lack of the awareness about the mental health
disease, poor socioeconomic condition, lack of safety and therapeutic communication
between the mental health workers and the subject plus family of the subject are greatly
implicated in the process of unplanned re-institutionalization of the mental health patients.
The lack of proper resources in the community setting, lack of self-care skills and the lack of
family support plus the most critical problem pertaining to the lack of the health literacy are
highly involved in the process of readmission back to the hospital’s psychiatric facilities.
The most critical aspect of finding that is done by the study is that the social stigmas about
the mental health diseases are greatly involved in the regression of the recovery back to the
disease condition and the ‘social malaise’ is highly involved in the same as well. Self-
regulation, self-management is deficient in most of the community life and thus the
knowledge and awareness as well as the economic, educational parameters has to bettered in
order to deliver a more well organized care to the psychiatric patients in the community
settings, thus decreasing the chances of unplanned readmission.

6
UNPLANNED READMISSION
Hamilton et al., (2016) aimed to study ‘Predictors of psychiatric readmission among
patients with bipolar disorder at an academic safety-net hospital’ and finds out that the level
of re-hospitalization in the patients is greatly attributed to the various aspects of the
functional spore interpretation of the patients. The negative aspects of the behavioral
outcomes such as the increased presentations of the self-harm behaviors in the aged patients
with brain generation and steady cognitive degeneration problems has been shown to impact
the level and rate of unplanned readmissions of the patients in the hospitals. It is highly
important to understand, as the researchers of this study explains that in diseases like
Parkinson’s diseases, Parkinsonism, Alzheimer’s diseases, dementia – there are increased
chances of self-harm at home due to environmental factors and the social reasons as well.
There are sharper, harmful objects and sources of fire within the reach at home and the risks
of falls due to the closely located objects are also very common at home. In addition, the
level of supervision required to address the risk and the hazards cannot surely done by the
family members as much as it can done by the clinicians at the hospitals. But longer stay of
the patients in the hospitals more is impact on the cost and expenditure (Šprah et al., 2017) .
Thus, as a matter of fact, it is more important that the occupational therapists and the physical
therapists should collaborate with the members of the family at home, after discharge and the
community mental health nurse also has a very important role in it. The researchers of the
study identifies lack of collaboration of these clinicians with the patient and with the family
of the patient as the most critical factors that gives chance to the presentation of situational
severities and risks for which the patient has to be readmitted in the psychiatry department,
completely unplanned.

7
UNPLANNED READMISSION
References
Duhig, M., Gunasekara, I., & Patterson, S. (2017). Understanding readmission to psychiatric
hospital in Australia from the service users’ perspective: a qualitative study. Health &
social care in the community, 25(1), 75-82.
Hamilton, J. E., Passos, I. C., de Azevedo Cardoso, T., Jansen, K., Allen, M., Begley, C.
E., ... & Kapczinski, F. (2016). Predictors of psychiatric readmission among patients
with bipolar disorder at an academic safety-net hospital. Australian & New Zealand
Journal of Psychiatry, 50(6), 584-593.
Hariman, K., Lam, J., Leung, S. K., & Lui, S. S. (2020). Clinical risk model to predict 28-day
unplanned readmission via the accident and emergency department after discharge
from acute psychiatric units for patients with psychotic spectrum disorders. BJPsych
open, 6(1).
Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., & Magnussen, J. (2016). Psychiatric
readmissions and their association with environmental and health system
characteristics: a systematic review of the literature. BMC psychiatry, 16(1), 376.
Lawn, S., Zabeen, S., Smith, D., Wilson, E., Miller, C., Battersby, M., & Masman, K. (2018).
Managing chronic conditions care across primary care and hospital systems: lessons
from an Australian hospital avoidance risk program using the Flinders chronic
condition management program. Australian Health Review, 42(5), 542-549.
Li, X., Srasuebkul, P., Reppermund, S., & Trollor, J. (2018). Emergency department
presentation and readmission after index psychiatric admission: a data linkage
study. BMJ open, 8(2), e018613.

8
UNPLANNED READMISSION
Looi, J., & Kisely, S. (2018). So we beat on, boats against the current, borne back ceaselessly
into the past-continued inaction on public mental health services.
Moore, C. O., Moonie, S., & Anderson, J. (2019). Factors associated with rapid readmission
among Nevada State Psychiatric Hospital patients. Community mental health
journal, 55(5), 804-810.
Ose, S. O., Kalseth, J., Ådnanes, M., Tveit, T., & Lilleeng, S. E. (2018). Unplanned
admissions to inpatient psychiatric treatment and services received prior to
admission. Health policy, 122(4), 359-366.
Sharma, Y., Miller, M., Kaambwa, B., Shahi, R., Hakendorf, P., Horwood, C., & Thompson,
C. (2018). Factors influencing early and late readmissions in Australian hospitalised
patients and investigating role of admission nutrition status as a predictor of hospital
readmissions: a cohort study. BMJ open, 8(6), e022246.
Šprah, L., Dernovšek, M. Z., Wahlbeck, K., & Haaramo, P. (2017). Psychiatric readmissions
and their association with physical comorbidity: a systematic literature review. BMC
psychiatry, 17(1), 2.
Zhou, H., Della, P., Roberts, P., Porter, P., & Dhaliwal, S. (2019). A 5-year retrospective
cohort study of unplanned readmissions in an Australian tertiary paediatric
hospital. Australian Health Review, 43(6), 662-671.