Reduction in inpatient length of stay and changes in mental health care in Israel over four decades: a national case register study.

BACKGROUND: The purpose of the present study was to investigate trends over the past 40 years in the accumulated length of hospital stay, and to consider how these trends might have been affected by changes in the provision of mental health care in Israel from 1960 to 1997. METHODS: The national psychiatric case register was used to follow four cohorts of all new admissions in 1960, 1970, 1980 and 1990 diagnosed with schizophrenia or affective disorders for the first seven years following the index admission. RESULTS: Most of the changes in length of stay occurred among patients with schizophrenia. The overall accumulated length of stay decreased by 50% between 1960 and 1980. The largest reduction was observed among long-stay patients with schizophrenia. Number of admissions did not change for the four cohorts. LIMITATIONS: The interpretation of the data remains speculative, as we are attempting to establish causality between parallel trends. CONCLUSIONS: The general trend in the findings of this study corresponds with changes that took place between 1970 and 1990 in the outpatient care for the mentally ill. These innovations facilitated the discharge of patients with chronic schizophrenia and altered the case mix of the newly admitted patients.