Heavy use of psychiatric inpatient care from the perspective of the patients affected

Background: Patients who spend an above-average amount of time in inpatient care are termed heavy users. Up to this point, very little has been known about what drives these patients to their heavy use of inpatient treatment. Aim: For this reason, the present study investigates the causes for frequent inpatient admissions of heavy users from the perspective of the patients affected. Methods: Twenty heavy users who were identified in a quantitative preliminary study were interviewed using a qualitative analysis of the contents. Results: Heavy users housed in sheltered accommodation either experienced frequent inpatient stays because of their symptomatic burden, or because of poor integration in their residences. Among the heavy users living in private residences was a subgroup that compensated for the lack of support from the private sphere with frequent hospital visits. A second subgroup turned to hospital care only during acute relapse episodes. In a third subgroup, secondary substance abuse accounted for the high demand for inpatient treatment. Conclusion: Findings suggest that, using community-based psychiatric support offers tailored to the needs of the heavy user subgroups, inpatient treatment could be avoided.