Early readmission to psychiatric units poses a significant challenge for both patients and healthcare institutions. It hampers patient progress and prognosis, and the professional approach taken during discharge can greatly influence the recovery process. This paper proposes a multicomponent discharge transition intervention to mitigate the risk of early readmission to a mental health hospitalization unit (MHHU). The present proposal consists of two distinct phases with two clearly differentiated main objectives. On the one hand, following an observational design, the development of a measurement instrument to assess patients’ risk of early readmission, allowing for stratification into the high-, medium-, and low-risk categories. On the other hand, according to a quasi-experimental design, the implementation and evaluation of the intervention program, with a focus on tailored interventions to ensure adherence and continuity of care post-discharge, with a more intensive approach for high-risk patients. A post-discharge psychotherapeutic group will also be introduced for high-risk cases to support recovery. The program’s effectiveness will be evaluated by comparing the early readmission rates at the Regional Hospital of Malaga’s MHHU to those of the previous year. Two other hospitals in the province, where the intervention is not applied, will serve as control groups. Success will also be measured through pre- and post-assessments of the recovery, functionality, subjective well-being, social support, and treatment satisfaction of those participating in the psychotherapeutic group. This proposal aims to address the issue of early readmission by enhancing predictability and understanding intervention strategies to reduce readmission rates.

Background: Mechanical restraint remains a common coercive practice in acute psychiatric wards and is particularly concerning in older adults due to greater physical and cognitive vulnerability. Methods: We conducted a retrospective observational study using routinely collected registry data from all recorded mechanical restraint episodes in 20 acute adult mental health inpatient units in the Andalusian public health system over 30 months. Among 2,435 restrained individuals with documented age, 19.4% (n=473) were ≥55. Age was modelled as a continuous predictor of (i) repeated restraint (any subsequent episode) and (ii) multiple restraints (≥3 episodes) using mixed-effects logistic regression with random intercepts for unit and adjustment for sociodemographic, diagnostic, and episode-related factors. Results: Compared with younger users, older restrained users were more often female and Spanish, more frequently had bipolar disorder and organic/intellectual disability diagnoses, and less often had substance use or personality disorders. They experienced a longer time from admission to the first restraint. Restraint was more often recorded as “required for another therapeutic activity” and less often due to “aggressive behavior”. During restraint, older users more frequently displayed confusion, and episodes more often began at night. Repeated restraint occurred in 27.2% of subjects; younger age was significant in univariable analysis but not after adjustment (aOR 1.004). Multiple restraint occurred in 23.0%; after adjustment, older age was associated with lower odds (aOR 0.992). Conclusions: Older adults showed a distinct restraint profile, supporting age-sensitive restraint-reduction strategies focused on frailty/confusional states in older individuals and preventing repeated episodes in younger users.

Early hospital readmission in mental health inpatients negatively affects patient outcomes and increases healthcare costs, making early risk identification crucial. This study aimed to develop a 30-day readmission risk index using a retrospective case–control design in the Mental Health Hospitalization Unit of the Hospital Regional Universitario de Málaga, including 196 admission episodes (98 early readmissions and 98 controls). Univariate and multivariate logistic regression analyses identified the following predictive variables: previous hospital admissions, presence of a personality disorder, high social risk, having used emergency services in the past year, having a legal capacity restriction, aggressive behavior at admission, and marital status. The resulting index demonstrated good predictive performance (AUC = 0.764), with internal validation showing an optimism-corrected AUC of 0.727 and acceptable calibration (slope = 0.796, intercept = −0.023). This tool may be useful for risk stratification and post-discharge planning, but should be used cautiously due to the exploratory nature of the study. Clinical trial registration: ClinicalTrials.gov , identifier NCT06604780.