An investigation of a referral linkage from a state psychiatric hospital to community mental health centers

Author

Lois J. Pokorny

Date of Award

8-1981

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Psychology

Major Professor

John W Lounsbury

Committee Members

Eric Sundstrom, John F Byrne, John W Edgerly

Abstract

The purpose of this study was to investigate the referral linkage from a state psychiatric hospital to community mental health centers. State psychiatric hospitals and community mental health centers (CMHC's) share the responsibility for the delivery of mental health services in the public sector. The CMHC is mandated to provide aftercare for residents of their catchment area who are leaving a state hospital. The present paper investigated the effectiveness of the procedure by which 52 patients being discharged from a state hospital were referred for aftercare at a CMHC. Two outcome measures were used: l) attendance at the referred appointment; and 2) readmission to the state psychiatric hospital within a year of discharge.

The attendance rate at the referred CMHC appointment for patients included in this study was 73.1 percent. Comparisons of demographic characteristics of patients attending and not attending the referral CMHC appointment revealed that females were more likely than males to attend (x² = 6.7, df = 1, p <.02). The recidivism rate for these patients to the state hospital within one year of discharge was 26.9 percent. Comparisons of demographic characteristics of patients returning and not returning to the state psychiatric hospital revealed that those with previous history of hospitalization were more likely to return (x² = 14.4, df = 2, p <.002). Patients were randomly assigned to either a control or augmented referral condition. The augmented referral condition included an additional contact with the patient before discharge to encourage attendance at the referred CMHC appointment. The proportion of patients attending in the two conditions was not significantly different.

A stepwise multiple regression analysis was calculated in which patient sex, referral condition, psychiatric symptomotology rating, and the interaction terms of these variables served as predictor variables and CMHC attendance served as the criterion variable. The resulting coefficient of .55 indicated that the prediction equation could account for approximately 30 percent of the variance in attendance. However, only sex and the interaction of sex and psychiatric symptomotology rating entered at a significant level. Similarly, a stepwise multiple regression analysis was calculated in which patient sex, referral condition, psychiatric symptomotology rating, number of previous hospitalizations, and the interaction terms of these variables served as predictor variables and recidivism to the state hospital served as the criterion variable. The resulting coefficient of .65 indicated that the prediction equation could account for approximately 42 percent of the variance in recidivism. However, only number of previous hospitalizations entered at a significant level.

A goal of the provision of aftercare is to prevent or delay readmission to the state hospital. The association between attendance at the referred appointment and readmission to the state hospital was not statistically significant. The probable factors contributing to the high attendance rate at the CMHC appointment and those contributing to the high recidivism rate to the state psychiatric hospital were discussed.

Recommended Citation

Pokorny, Lois J., "An investigation of a referral linkage from a state psychiatric hospital to community mental health centers. " PhD diss., University of Tennessee, 1981.
https://trace.tennessee.edu/utk_graddiss/13502