Right-Sizing Acute Mental Health Care? Emerging Outcomes from Statewide Implementation of Critical Time Intervention

Background & Purpose: Critical Time Intervention (CTI) is an evidence-based program that has been shown to decrease readmission among individuals with severe mental illness discharged from inpatient psychiatric care. In New Hampshire, CTI was implemented statewide within the Community Mental Health Centers to assist individuals transitioning from psychiatric hospitalization to the community. While CTI has been implemented broadly to assist marginalized populations through various transitions, success with statewide implementation in the US is not yet widely demonstrated.

Methods: CTI program-level performance data was collected on program outcomes including occurrences of hospital readmission from January through December 2022. Data collected from a state-wide database and from the State’s psychiatric hospital were used to create a comparison group of individuals who had not received CTI support. Hospital readmissions, lengths of stay, and monthly readmission averages by discharge cohort were compared between CTI program participants and those who had not received CTI support following discharge from state designated psychiatric facilities.

Results: Among individuals who received CTI services (n = 204), fewer individuals were readmitted at 30, 60, and 90 days from their initial hospital admission when compared to those who were discharged without this support (n = 3,946). For example, at 90 days post-discharge, 5.9% of individuals who received CTI had been readmitted (n = 12) compared to 10.2% of those who had not (n = 403). Additionally, when the average monthly lengths of stay were compared between those discharged with CTI support and without, lengths of stay were considerably shorter among individuals who received CTI. For the non-CTI group, average monthly lengths of stay ranged from 5.5 to 26.38 days, with an average of 16.06 days. For those receiving CTI, average monthly lengths of stay ranged from 0 to 22.33 days, with an average of 3.39 days. Additionally, monthly readmission percentages were compared between discrete cohorts receiving CTI and those who did not. For those not receiving CTI, cohorts showed some level of readmission for most subsequent months throughout the year, with average readmissions ranging 0 to 6%, and an average monthly rate of 2.2%. For individuals receiving CTI, cohorts showed infrequent and intermittent readmissions compared to peers who did not get CTI. Average monthly readmissions for cohorts of individuals receiving CTI ranged from 0 to 25%, with an average monthly rate of 1.44%.

Conclusions & Implications: Emerging data suggests that individuals receiving CTI are readmitted less frequently and experience shorter stays when readmitted. However, while infrequent, clients receiving CTI are returning to the hospital when needed. Early data from the statewide CTI program has shown promising results, suggesting that with short-term support through hospital discharge, individuals were able to live successfully in the community connected to supports, and gain access to necessary care when needed. Future statistical testing and analysis of additional healthcare effectiveness data is required to determine if CTI can right-size acute mental health care and contribute to lessening the burden on emergency mental health services.