Association 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 re-hospitalization, environmental factors largely have been ignored. The current study examined stability of patients' living situation in relation to hospital re-admissions and psychiatric emergency service (PES) visits. Subjects were recruited from acute inpatient psychiatry units at a large, urban county hospital. Data on psychiatric re-hospitalizations and PES visits were collected from an electronic medical record database and participant interviews over 12-months time. The sample (n=94) was 66% male; age M=39.2 years (SD=11.2); 42% 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. Overall, 54% of the sample experienced re-hospitalization or services in PES. Re-hospitalization and PES visits were greater among participants with unstable (57%) versus stable (43%) housing. Stability of housing was significant in a multivariate model controlling for demographics, psychiatric factors, and prior hospitalizations, (β=.345, p=.048). The findings suggest efforts to secure stable housing for mental health patients may help offset costs currently used for acute care.