The effect of the implementation of the rehabilitation of the mentally disabled in the community law in Israel on the pattern of psychiatric hospitalizations

In 2001 the Rehabilitation of the Mentally Disabled in the Community Law was implemented in Israel, defining a basket of rehabilitation services to which the mentally disabled are entitled. The objectives of the present study were to examine the effect of being placed in a rehabilitation program after discharge from a psychiatric hospitalization on the probability of rehospitalization and on the length of the following hospitalization if it occurred. Anonymized data were extracted from two registers of the Ministry of Health: the Rehabilitation Register and the Israeli Psychiatric Case Register, whose data were merged. The study population consisted of all the discharges from a psychiatric hospital during 2001-8. There were three study groups (those admitted to hostels, supportive housing, and vocational rehabilitation) and two control groups (those referred to rehabilitation and did not implement the referral and a matched control group of potential candidates for rehabilitation). Kaplan-Meyer survival and Cox analysis were performed on the data. The results showed that the probability to stay in the community after discharge was higher in all the study groups compared to those who were referred but did not reach the rehabilitation system and to the matched control group of potential candidates. Moreover, if the patients were rehospitalized, the probability of a short duration of the next inpatient episode was higher among all the study groups compared to the control groups. The results emphasize the beneficial effect on the pattern of psychiatric hospitalization of the legislation regarding national rehabilitation services for the mentally disabled.