Hospitalization of patients with schizophrenic and affective disorders in Israel in the aftermath of the structural and rehabilitation reforms

BACKGROUND: In the last decade (2001–2010) the Ministry of Health implemented two major inter-related reforms: a ’structural reform’ to reduce the number of psychiatric beds and the ’Rehabilitation of the Mentally Disabled in the Community Law’, which allocated funds for a variety of residential and vocational programs in the community for these patients. The objective of the present paper was to examine the impact of the two reforms on the hospitalization of schizophrenic and affective disorder patients by tracking the patterns of their inpatient care during the last decade. METHODS: Data on all psychiatric admissions during the period 1990–2011 were extracted from the Israel Psychiatric Case Register to examine changes in the rate of admissions, length of hospitalizations, total inpatient days and tenure in the community. The analysis was done separately for first-in-life vs. all admissions and for patients with schizophrenia vs. patients with affective disorders. RESULTS: From 2006 onward, with no decrease in the number the beds, the number of inpatient days for first-in-life patients with schizophrenia decreased by 29%, their admission rates dropped by 22%, the proportion of short [< 30 days] first in life episodes went up, while the percentage of those whose first in life episode lasted more than one year went down from 2.5% to 0.5%. The parallel results for patients with affective disorders were much less significant. CONCLUSIONS: An increasing percentage of patients with schizophrenia are not admitted to psychiatric wards at all and an increasing percentage of those who are admitted are treated during a shorter episode. The change is probably due to the rehabilitation reform which enabled the structural reform (the reduction in beds) to be implemented effectively.