Relationship between housing stability and hospital readmissions among patients with mental illness

Acute inpatient psychiatry stays are costly, and rates of readmission are high: 44% within 12 months time among hospitalized psychiatry patients in California. While prior studies have identified patient demographic (age, gender, education) and psychiatric factors (psychosis, prior hospitalizations) in predicting rehospitalization, environmental factors largely have been ignored. The current study examined stability of patients' living situation in relation to hospital readmissions. Subjects were recruited from acute inpatient psychiatry units at a large, urban county hospital. Data on rehospitalizations were collected prospectively from an electronic medical record database and participant interviews over 6-months time. The sample (n=100) was 65% male; age M=39.5 years (SD=11.3); 44% non-Hispanic White; 46% on Medicaid; and 79% unemployed. Only 11% rented or owned their own home, 25% lived in a friend or relative's home, 11% were in a drug treatment facility, 3% were incarcerated, and 50% were homeless or living in a shelter, SRO, or board and care. Nearly half the sample (48%) reported an unstable living situation prior to hospitalization, defined as residence for < 6 months. Participants lost to follow-up (n=3) or deceased (n=3) were dropped from analyses. Overall, 62% of the sample experienced rehospitalization. Rehospitalization was significantly greater among participants with unstable (73%) versus stable (51%) housing, χ2(1)=4.94; p=0.026. Stability of housing remained a significant factor in a multivariate model controlling for demographics, psychiatric factors, and prior hospitalizations, β=0.218, p<0.008. The findings suggest efforts to secure stable housing for mental health patients may help offset costs currently used for acute care.