There is widespread recognition among clinicians, researchers, individuals with serious mental illness and their families that involving family members in the mental health care of their loved ones is essential to providing quality and effective care. However, little is known about the effects of family involvement on inpatient care and how that involvement can be sustained upon discharge to an outpatient setting. 
 
In a new study published online this week in Psychiatric Services, Morgan Haselden and authors from New York State Psychiatric Institute and Columbia University analyzed Medicaid claims and closed medical records from two major urban community hospitals. The authors examined family involvement in inpatient hospitalization care from these records, where "family" also includes any individual who has a close relationship with the patient and provides support.

The authors found that there is a significant association between family involvement in inpatient care and both the creation of a comprehensive patient discharge plan and prompt continuation of treatment in an outpatient setting. The frequency of family involvement by the inpatient staff was assessed, including family visits during hospitalization, attendance of family meetings or therapy sessions, and discussing post-discharge treatment planning with staff. The results suggest that even a low level of family involvement at relatively low effort from clinical staff had a considerable effect on outcomes.  

"This finding lends support to the benefits of family involvement in mental health care and adds new evidence that these benefits extend to the psychiatric hospitalization setting," Haselden and authors write. "Furthermore, family involvement was associated with patients' receiving more comprehensive discharge planning, underscoring the importance of family involvement and its impact on treatment." 

Study findings 

The results indicate that 75% of the patients in the sample had a family member contacted by staff during their inpatient hospitalization. Only 37% of the patients were discharged with a comprehensive treatment plan and 53% attended an outpatient mental health care appointment within one week. Notably, any involvement of the family with inpatient staff was associated with an increased likelihood of attendance of outpatient care appointments after discharge from the hospital at both seven- and 30-days follow-up. Other findings from the study included: 
  • Patients with a length of hospitalization of one week or more were 2.5 times more likely to have a comprehensive discharge plan than those whose stay was six days or less. 
  • Hospitalized individuals with serious mental illness who also had a co-occurring substance-use disorder were less likely to have family involvement in their care and less likely to have been discharged with a comprehensive plan compared to those without a substance-use disorder.  
  • Patients with serious mental illness who were less than 21 years old were more likely to have family involvement in their care.  
Of importance, 14 people, almost 10% of the sample, refused to have family involvement in their care. The authors argue that in some cases it may be important to limit family involvement if the relationship is not a positive one. However, prior research supports the notion that inpatient staff should consider both the family member and individual patient's viewpoint in treatment decisions and discharge planning when the patient refuses any involvement of their family members, according to the authors.  

As we wrote in our May 14, 2019  research blog  on shared decision-making and the importance of family involvement, "in practice, caregiver or family member involvement in mental healthcare decision-making is rarely explicitly addressed." In agreement, Haselden and fellow authors argue that this discrepancy is even more pronounced in inpatient care, despite recognition of the value of involving family members. More information and education are needed to better inform inpatient care and promote the inclusion of family members in such practices.

References:

Elizabeth Sinclair
Director of Research
Treatment Advocacy Center