Psychiatric hospital admissions and linkages to ambulatory services in the Western Cape Province of South Africa (2015-2022): trends, risk factors, the impact of the COVID-19 pandemic and possible opportunities for intervention

Abstract Background Psychiatric hospital admissions in the Western Cape are increasing, driven by poverty and substance use. Aim To assess the trend of psychiatric admissions from 2015-2022 and factors associated with repeat psychiatric admissions and linkage to ambulatory services post-discharge. Setting Public hospitals in the Western Cape, South Africa Methods Using electronic data from the Provincial Health Data Centre, a consolidated routine service database, all psychiatric hospital admissions in the Western Cape were analyzed, stratified by hospital level. Mixed effects logistic regression was used to determine factors associated with successful linkage to ambulatory services within 30 days following hospital discharge, and repeat psychiatric admission within 30 and 90 days. Results Psychiatric hospital admissions, particularly at the district/acute level, were increasing prior to 2020 and an increasing proportion were substance related. 40% of admissions at the district level had not been seen at a primary health care facility in the year prior to admission. Males and those with substance use disorders were less likely to be successfully linked to outpatient services post-discharge. Successful linkage was most protective against readmission within 90 days with an adjusted odds ratio of 0.76 (95%CI 0.73-0.79) and 0.45 (95%CI 0.42-0.49) at district/acute and specialized hospitals respectively. Conclusion Improving linkage to ambulatory services for mental health patients post-discharge is likely to avert hospital readmissions. Contribution This research highlights how often mental health patients requiring admissions are not seen at the primary health care level and quantifies the risk for readmission of not following up psychiatric admissions post-discharge.