Are the same patients being readmitted to your mental healthcare facility within a few weeks, months or years of being discharged? Are your healthcare costs on the rise as a consequence of this? 

In the healthcare industry, we use the term “revolving door” to describe a situation where patients repeatedly come back to the same service with the same health issues. The patients are in and out of services in a cycle without achieving long-term stability or improvement in their health. It is a problem as frustrating as it is costly for healthcare providers which is why we wanted to help by providing you with as much information as we can to help you stop the revolving door syndrome. 

As experts in the field of Clinical Psychology with 20+ years of experience working with the NHS and private healthcare providers, we at RESET have a deep understanding of the revolving door syndrome, its causes and solutions. After all, it was to tackle that issue that we founded the company in the first place! 

We are writing this blog because we are passionate about long-term solutions in healthcare and will aim to give you as much objective information as possible. What matters to us is to support healthcare decision-makers implement long-term change, whether they decide to implement the RESET model or not. 

Therefore, this blog will cover:

• Signs that you have a revolving door problem
• What factors contribute to the revolving door syndrome
• Why is it important to address the revolving door problem
• What can you do in your organisation to address the revolving door syndrome
• Next steps towards stopping the revolving door syndrome

Signs that you have a revolving door problem

Identifying whether there is a revolving door problem in mental health can be challenging and requires careful evaluation of various factors. Here are some indicators that suggest the presence of a revolving door problem in your organisation: 

• High readmission rates: A significant number of individuals are being readmitted or are receiving repeated crisis interventions. 
• Lack of sustained improvement: Individuals are not achieving long-term recovery.
• High dropout rates: A high rate of disengagement or treatment non-compliance. 
• Short treatment durations: Patients are receiving brief episodic treatments without adequate follow-up or support. 
• Overburdened emergency services: A consistent high influx of mental health-related crises within emergency departments.

Additionally, overcoming the revolving door problem in mental health is difficult due to resource constraints, fragmented healthcare systems, complex mental health needs, limited community-based support, treatment adherence, societal and systemic factors, and the need for a comprehensive approach. 

Therefore, identifying and addressing the revolving door problem may leave you feeling overwhelmed but we are here to help you on that journey. 

What factors contribute to the revolving door phenomenon?

Several factors contribute to the revolving door phenomenon: 

• Lack of access to necessary resources: Patients with chronic diseases or complex health issues may require ongoing medical attention and management. If their conditions are not effectively controlled or if they lack access to necessary resources, they may experience exacerbations or complications, leading to repeated hospitalizations.
• Lack of Continuity of Care: Inadequate coordination and continuity of care can contribute to the revolving door phenomenon. When patients do not have a well-established primary care provider or a comprehensive care plan, they may struggle to manage their conditions outside of the hospital setting, increasing the likelihood of readmissions.
• Housing and Social Situation: Social determinants of health, such as poverty, unstable housing, limited access to transportation, or lack of social support, can make it challenging for individuals to adhere to treatment plans or access appropriate follow-up care. These factors can contribute to a cycle of hospital readmissions.
• Institutionalisation: Individuals become dependent on the service. They have fully adapted to the routines and norms of the service, and find it hard to adapt to life in the community. They often find themselves isolated and lonely when discharged and therefore end up being re-admitted to benefit from the emotional and social support of the service. 
• The biomedical model: Health professionals often treat physical ailments, without looking at the psychological or environmental impact of physical illnesses and their treatment (side effects). Insufficient consideration of the psychological and social well-being of the patient can lead to a lack of treatment adherence and recurrent hospital admissions.

Why is it important to address the revolving door problem?

• Improved patient outcomes: By breaking the cycle of repeated crises and short-term interventions, individuals can have better long-term outcomes in managing their mental health. Access to comprehensive care can help individuals stabilize, recover, and maintain their well-being over time. 
• Enhanced quality of care: Addressing the revolving door problem promotes the delivery of high-quality and evidence-based care. It encourages the development of care plans that consider the individual’s unique needs, leading to more effective treatment interventions. 
• Cost-effectiveness: Breaking the revolving door cycle can reduce healthcare costs in the long run. By focusing on preventive measures, early intervention, and ongoing support, healthcare resources can be used more efficiently, decreasing the need for expensive crisis-oriented care and hospitalisations. 
• Increased efficiency in healthcare delivery: When patients receive continuous and coordinated care, healthcare providers can work together more effectively. Improved collaboration between professionals contributes to more efficient care delivery, minimising the duplication fo services and optimizing resource allocation. 

What can I do in my organisation to address the revolving door phenomenon? 

If you want to increase patients’ outcomes and recovery rates, it requires a comprehensive and integrative approach, considering the physical health of the patients as well as their psychological and social-economic well-being (environmental factors): 

• Integrated Care: Improving teamwork and communication between physical and mental health professionals in your organisation is crucial. Patients’ self-perception and self-esteem are going to affect how they look after themselves, their motivation to implement change and to maintain those changes.  Low mood, perceived boredom, perceived lack of purpose and other depressive symptoms affect patients’ recovery. Therefore patients with chronic diseases or complex health issues may require ongoing psychological support to increase treatment compliance and implement lifestyle changes. You can read more about how you can move towards an integrated approach to care to tackle the revolving door problem and improve patient outcomes whilst reducing costs.

• Community Support: Improving care coordination between inpatient and outpatient services is in your service crucial. Ensuring smooth transitions and effective communication during discharge planning can increase patients’ treatment adherence and increase patient outcomes. Additionally, expanding access to community-based resources during and after admission can help patients to receive the appropriate support they need to manage their conditions and prevent unnecessary hospital readmissions.
• Psychoeducation/ self-awareness: Organising individual or group psychoeducation sessions can enhance knowledge and understanding and help patients gain a better understanding of themselves and their conditions. When patients have a clear understanding of their condition and its management, they can make informed decisions and feel more confident about the effectiveness of their treatment.
• Socioeconomic Factors: Implementing a comprehensive initial assessment to understand the patients’ living circumstances will help to understand the patients’ recovery capital. Recognizing and addressing the socioeconomic factors that contribute to patients’ recovery is essential. Collaborating with other professionals (i.e. housing officers, social workers, etc.) can help patients access resources to overcome barriers to care.

By addressing the aforementioned/above factors, The RESET Teams have been able to collect outstanding results in terms of patient outcomes and long-term stability/recovery rates in the services that they have supported. However, if you are going to implement this yourself, our last piece of advice would be: “Change is a process not a 1-off event!”. Through our work at RESET, we have witnessed how impatience can sabotage our best effort and stop us from reaping the benefits of our hard work. We did not learn to walk in a day. Change is a slow process…

In this article, you learned about the revolving door phenomenon in mental health. We discussed how healthcare providers can address this phenomenon by improving teamwork and communication between physical and mental health professionals, expanding access to community-based resources, organizing psychoeducation sessions, and implementing a comprehensive initial assessment.

If you are interested in taking steps to address the revolving door phenomenon in your organization, here are some next steps you can take:

• Assess your organization’s current practices and identify areas where improvement is needed.
• Develop a plan for implementing the strategies discussed in this blog.
• Get buy-in from key stakeholders, including patients, families, and healthcare providers.
• Implement the plan and track your progress.
• Make adjustments to the plan as needed.

If you liked this article, you might also like to read about What is an integrated approach to care.

And if you have any questions about this topic, please feel free to email us at admin@theresethealthgroup.com. We will be delighted to offer you advice on how to start seriously addressing the revolving door problem in your healthcare organisation.

Msc Saiyuri Naidu is a Senior Assistant Psychologist at the RESET Health Group and an MSc Clinical Psychology Graduate with a special interest in trauma and how this can affect an individual’s mind and body.