The Contribution of Community Rehabilitation to Reducing Psychiatric Hospitalization in the Mental Health System

The extent of psychiatric hospitalization has greatly decreased in recent years. Concomitantly, in the latter 1990s a system of community rehabilitation developed. This study examined the impact of broader rehabilitation on the reduction in hospitalization, beyond other changes in the system, such as hospitalization policy and pharmacological and outpatient developments.

The study was conducted in collaboration with the Ministry of Health and is based on national data on all patients hospitalized in psychiatric hospitals and wards since 1955 and on recipients of one or more community psychiatric rehabilitation services from the mid-1990s until 2007. The data were linked on the level of the individual. The impact of rehabilitation was examined in various complementary ways, and the relationship between receipt of rehabilitation and extent of hospitalization by two main methods:

  • Macro-level Method. We examined the trend of change in the extent of hospitalization separately for recipients (at any time) and non-recipients of rehabilitation among all people hospitalized over the years. A much greater reduction in hospitalization was found among the recipients: the average number of hospitalization days per patient decreased considerably from 97 in 1990 to 24 in 2007; among non-recipients, the decrease was from 28 in 1990 to 10 in 2007. A similar trend of reduction was found in the percentage of people hospitalized.
  • Individual-Level Method. Among people in rehabilitation, the extent of hospitalization was compared for the same number of years before and after starting rehabilitation. To validate the findings, various sub-groups and timeframes were examined. All the examinations and measures revealed a considerable reduction in hospitalization after rehabilitation began, compared with the previous period.

To illustrate, the average number of hospitalization days per patient per annum decreased as follows:

  • The examination of all patients who began rehabilitation revealed that the annual hospitalization average per person decreased from 75 days (in an average period of four years before starting rehabilitation) to an average of 19 (in an average period of four years after)
  • Among people entering rehabilitation in different years: e.g., beginning in 2000 – from 121 before to 10 after; and beginning in 2007 – from 46 to 10
  • For recipients coming to rehabilitation from long-term hospitalization, the average decreased from 227 to 32; from short-term hospitalization – from 76 to 31; from the community – from 34 to 12.

In summary, both methods and all examinations revealed a substantial relationship between the receipt of rehabilitation services and the extent of hospitalization. It is thus safe to conclude that community rehabilitation reduces hospitalization considerably. Since the rehabilitation system is continuing to expand and develop, it may well exert an even greater impact in the future.

The study was made possible thanks to funding from the Laszlo N. Tauber Foundation.

Citations in the professional and academic literature

Roe, D., Gelkopf, M., Gornemann, M. I., Baloush-Kleinman, V., & Shadmi, E. (2015). Implementing routine outcome measurement in psychiatric rehabilitation services in Israel. International Review of Psychiatry27(4), 345-353.

Hornik-Lurie, T., Zilber, N., & Lerner, Y. (2012). Trends in the use of rehabilitation services in the community by people with mental disabilities in Israel; the factors involved. Israel journal of health policy research1(1), 24.

Gelkopf, M., Lapid, L., Werbeloff, N., Levine, S. Z., Telem, A., Zisman-Ilani, Y., & Roe, D. (2016). A strengths-based case management service for people with serious mental illness in Israel: A randomized controlled trial. Psychiatry research241, 182-189.

Hasson-Ohayon, I., Mashiach-Eizenberg, M., Arnon-Ribenfeld, N., Kravetz, S., & Roe, D. (2017). Neuro-cognition and social cognition elements of social functioning and social quality of life. Psychiatry research258, 538-543.

Citing suggestion: Struch, N., Shereshevsky, Y., Naon, Denise., & Fishman , N. (2011). The Contribution of Community Rehabilitation to Reducing Psychiatric Hospitalization in the Mental Health System. ES-36-11. Myers-JDC-Brookdale Institute. (Hebrew)