Regular house calls found to cut re admission rates by 43%, hospital stays by two-thirds

THE Institute of Mental Health IMH is scaling up its outpatient services, after seeing how regular house calls have helped cut re-admission rates by 43 per cent and hospital stays by two-thirds.

It plans to ramp up its Community Mental Health Teams (CMHTs), which now have a staff strength of 51, comprising doctors, nurses, medical social workers, occupational therapists and psychologists.

Dr Lee Cheng, chief of the department of community psychiatry at IMH, said that additions will be made to the team "as we expand our services and widen our networking with partners in the community".

Although he did not go into details, there are a number of ways to help reduce unnecessary hospital re-admissions for the 30,000 mentally ill patients who receive outpatient treatment in Singapore.

One way is to expand its services to support patients from the Singapore General Hospital and National University Hospital.

Voluntary welfare organisations (VWOs) and religious organisations can also be roped in to make sure mental outpatients can live and function in the community.

The proposed move follows a blog entry by Health Minister Khaw Boon Wan last month, highlighting CMHTs as one of the mental health programmes his ministry intends to scale up this year.

"This service has helped reduce the number of Emergency Department visits and hospitalisations for some of the patients," he wrote.

CMHTs make regular house calls to adult patients with chronic mental illnesses largely schizophrenia - in the central eastern and western sectors of Singapore. The size of each team depends on the severity of the patient's mental disorder.

Dr Chua Hong Choon, vice-chairman (clinical) of the IMH Medical Board, said such proactive moves have shown good results. Patients have been re-admitted fewer times, and have stayed for shorter periods when hospitalised.

"It used to be three to six months' hospital stay for acute mental cases, but now the length of stay is between 20 and 30 days," he said.

The Straits Times learnt that the re-admission rate at IMII has dropped by 43 per cent.

IMH has a bed capacity of 2,000 and at any one time there are between 1,600 and 1,700 inpatients.
 
Of all the patients warded at IMH two out of three are long-term ones who cannot be discharged from hospital.

Dr Chua said scaling up the CMHTs would help empower the one-third of mental patients who could be discharged to live at home and work in the community, even as they continue with their medications and treatment.

But the responsibility should not lie with the CMHTs alone.

Dr Lee said that family members and caregivers of the patients need to also help out as the hospital team is not able to continuously monitor and control a patient's behaviour at home.

He added: "While the team provides the crutches on which the patients learn to cope in society, it is equally important for the family members to know that they also play a significant and crucial role in the overall care and management of the patient."