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A total of 1437 first admissions to a closed therapeutic community ward from 1977 to 1992 were assessed for subsequent readmissions. The ward had a double function: both crisis intervention and psychosocial rehabilitation. During the follow-up time, 515 (36%) patients were rehospitalized. One-third of the patients (187 cases) were rapidly readmitted within 3 months of discharge, whereas 328 patients were readmitted later, after 3 months. The association of rehospitalization with some patient and program characteristics was analyzed by the time to an event analysis (survival analysis), using the Cox regression model. A generally increased readmission rate was associated with young age (less than 23 years), psychosis diagnosis, and active participation in individual therapy. Rapid readmission (within 3 months) was linked to active participation in individual therapy and a poor immediate institutional outcome, and it was seen as a clinical necessity in crisis cases even though their first treatment episode was partly unsuccessful. Later readmission (after 3 months) was associated with an earlier long stay and a positive institutional outcome; it was seen as a part of the long-term psychosocial rehabilitation for patients who had responded well to the therapeutic community. Thus the double function of the ward under study - crisis intervention and psychosocial rehabilitation - was reflected in these two types of rehospitalization.Admission, Cox regression, Psychiatric hospital, Rehospitalization, Therapeutic community.

In an acute patients' therapeutic community 1173 patients were treated in 1977-90. During their 2090 treatment episodes 94% participated moderately or very actively in individual psychotherapy. The associations of participation were analyzed, on the basis of polytomous logistic regression analysis. Non-participation (2% of all episodes) was associated with the first treatment episode, a stable therapeutic community policy, and a short treatment time of less than 18 days. The determinants of passive participation (4%) were young age of less than 23 years, rural dwelling place, involuntary admission, treatment time of less than 81 days, and a diagnosis of personality disorder, typical schizophrenia, or other psychosis. A moderately active participation (35% of all; very active, 59% as a referent) was associated with male sex and young age of less than 23 years, low professional and social background, involuntary admission, unstable treatment policy, short treatment time of less than 40 days, and a diagnosis of borderline psychosis or typical schizophrenia. In summary, modifications in inpatient psychotherapy and an integration into the whole treatment entity are necessary when encountering young, minimally educated, nonmotivated, often male patients prone to nonparticipation.