The changing careers of patients with chronic mental illness: A study of sequential patterns in mental health service utilization

• Published in: Journal of mental health administration Vol. 23; no. 4; pp. 458 - 470
• Main Author: Wuerker, Anne K.
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.10.1996
• Subjects: Adolescent; Adult; Chronic Disease - epidemiology; Chronic Disease - therapy; Cluster Analysis; Data collection; Emergency services; Ethnic Groups - statistics & numerical data; Female; Health Care Utilization; Health services; Health services utilization; Homeless mentally ill people; Homeless people; Homeless Persons - statistics & numerical data; Homelessness; Humans; Inpatient care; Los Angeles - epidemiology; Los Angeles County; Los Angeles, California; Male; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental health care; Mental Health Services; Mental Health Services - standards; Mental Health Services - trends; Mental Health Services - utilization; Mental Illness; Patient admissions; Patients; Patterns; Population; Prisons; Public Health Administration - statistics & numerical data; Schizophrenia; Sequences; Studies; Substance abuse treatment; Use; Utilization Review; Los Angeles; United States > US
• ISSN: 0092-8623; 1094-3412; 1556-3308
• DOI: 10.1007/BF02521029

The aim of this study was to describe patterns of service use over time by a group of persons with chronic mental illness who were homeless at the time of the index admission. Subjects were all persons admitted to Skid Row Mental Health Services in a recent year who had 25 or more previous admissions to any Los Angeles County Department of Mental Health service (N = 49). Sequences of type of service at each of the 25 admissions were compared with optimal matching and categorized with cluster analysis. Patients in earlier clusters had many inpatient admissions; those in later clusters had many admissions to outpatient, residential, and jail services. Service use by individuals in each cluster showed the same trends. However, there were also different patterns of service use for patients in cluster within the same tie frame. Analyzing multiple admissions sequentially helps to locate likely places to intervene in downward-spiraling careers.