Characteristics of Inpatient Psychiatric Care’s Highest Utilizers — And How to Tackle Them

Individuals who drop out of high school, who are diagnosed with schizophrenia or who have a co-occurring personality disorder are more likely to make frequent use of inpatient psychiatric services, according to the results of a new study published in the Journal of Health Care for the Poor and Underserved.

For the study, researchers at the University of Texas Health Science Center at Houston (UTHealth) used machine learning to examine the health record data of more than 9,800 patients admitted to the UTHealth Harris County Psychiatric Center from January 2014 to December 2016. Machine learning involves the analysis of data calculated by artificial intelligence methods.

Using machine learning, researchers set out to determine what factors play a role in someone being a “high utilizer” of inpatient psychiatric services. The study defines high utilizers as those who have at least three inpatient psychiatric hospital admissions within a year.

The findings pointed to three factors being associated with high utilization: being a high school dropout, having schizophrenia and being diagnosed with a co-occurring personality disorder.

The researchers also highlighted suggestions for those predictors:

• For those who did not finish high school, mental health literacy should be routinely assessed. These individuals should also ideally be connected with educational support programs to improve health outcomes.
• For those with schizophrenia and co-occurring personality disorders, better identification and treatment at the time of the first episode of psychosis is needed. Additionally, assessment and treatment for co-occurring personality disorders should be integrated into community-based psychiatric treatment.

The study is noteworthy in economic terms and makes the case for early-stage, community-based behavioral health intervention. According to the National Alliance for Mental Illness, untreated mental illnesses costs the American economy up to $300 billion annually. Those costs could potentially be minimized if state and federal regulators were to invest more funding and attention in community-based behavioral health providers.

“Both schizophrenia and personality disorders can be difficult to treat, and many patients with these diagnoses are disadvantaged and vulnerable to health disparities,” a co-author wrote in the study. “We really need evidence-based treatments in place to help these patients avoid repeat hospitalizations, and this study is a great first step in helping to identify the appropriate outpatient resources to help these patients remain stable in the community and avoid repeat hospitalizations.”