For many of those with severe mental illness, their first significant treatment experience is hospitalization. There are important reasons why this is often the preferred treatment. In the hospital, the person can be observed to ensure that he or she is not a danger to self or others. The hospital is also the best environment to try out different medications in an attempt to reduce psychotic symptoms. Many medications have side effects that range from mildly annoying to highly dangerous; often these side effects can be very frightening or very uncomfortable. Side effects are often treated with medication changes or the addition of medicines designed to specifically treat their effects. Despite the fact that hospitalization is sometimes required to stabilize symptoms and determine the most effective medication regimen, from the patient's point of view it can be a frightening and dehumanizing experience. On the typical psychiatric ward, locked doors, limited visiting hours, and restricted use of telephones leave people feeling cut off from the outside world. Sometimes the experience of hospitalization is traumatic in itself, for example, when a person is physically restrained or is forced to spend time in a "quiet room." Inpatient hospital treatment will be discussed in greater detail in Chapter 14.
After being discharged from the hospital, what is the likelihood of rehospitalization? One of the most illustrative articles on this topic was published by Anthony, Cohen, and Vitalo (1978). By comparing the reported recidivism (rehospitalization) rates from the studies available at the time (see Table 3.1), the authors demonstrated that the probability of relapse in the short term (1 to 5 years) is very high. An examination of Table 3.1 reveals that as the follow-up period increases from 3 months to 5 and 10 years, the corresponding cumulative rate of recidivism also increases from 10% to 15% to as high as about 75%. Clearly, if you have been hospitalized because of a serious mental illness, the chance you will need rehospitalization at some point in time is very high. This high risk of relapse is true of schizophrenia, schizoaffective disorder, major depression, and bipolar disorder.
In recent years these figures have improved in terms of the proportion of individuals who relapse. For example, the 1-year relapse rates have decreased from a range of 20% to 40% to a range of 15% to 23% for individuals being treated with antipsychotic medication (Leucht et al., 2003). Klinkenberg and Calsyn (1996) reviewed research on predictors of recidivism among individuals with severe and persistent mental illnesses. They found that those individuals receiving aftercare (post-hospital care) and assertive community treatment (see Chapter 7) in addition to their medication experienced lower rates of rehospitalization.
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