Abstract: We included six relevant trials undertaken between 1969 and 1980. We found no significant difference in death (n = 175, 1 RCT, RR in the longer term 0.42, CI 0.10 to 1.83, very low quality evidence). In the long term, there was no difference in improvement of mental state (n = 61, 1 RCT, RR 3.39, CI 0.76 to 15.02, very low quality evidence). There was no difference in readmission to hospital (n = 651, 4 RCTs, RR by the long term 1.26, CI 1.00 to 1.57, low quality evidence). Data for leaving the study prematurely by the longer term showed no difference (n = 229, 2 RCTs, (RR 0.77, CI 0.34 to 1.77, low quality evidence). There was a significant difference favouring short stay (P = 0.01) in numbers of participants with delayed discharge from hospital exceeding the time planned in study (n = 404, 3 RCTs, RR in the longer term 0.54, CI 0.33 to 0.88, low quality evidence). There was no difference in numbers of participants lost to follow-up (n = 404, 3 RCTs, RR by the longer term 1.07, CI 0.70 to 1.62, low quality evidence). Finally, there was a significant difference favouring short-stay hospitalisation for social functioning, including unemployment, unable to housekeep, or unknown employment status (n = 330, 2 RCTs, RR by longer term 0.61, CI 0.50 to 0.76, very low quality evidence). The effects of hospital care and the length of stay is important for mental health policy. We found limited low and very low quality data which were all over 30 years old. Outcomes from these studies do suggest that a planned short-stay policy does not encourage a 'revolving door' pattern of admission and disjointed care for people with serious mental illness. More large, well-designed and reported trials are justified especially where a short-stay policy is not routine care.

Plain-language summary: The review aims to determine what length of stay in hospital is the most helpful and is now based on a 2012 search. Six randomised trials are included that compare short stay in hospital with either long stay in hospital or standard care. No differences were found between groups in readmission to hospital, mental state, leaving the study early, risk of death and people lost to follow-up. There was a significant difference favouring short-stay hospitalisation for social functioning. There was limited information that suggested that short-stay hospitalisation does not encourage a ‘revolving door’ pattern of admission to hospital and disjointed or poor care. This should reassure people with mental illness coming into hospital that a short stay (of less than 28 days) means they are no more likely to be readmitted, to leave hospital abruptly, or to lose contact with services after leaving hospital than if they received long-stay care. Short-stay patients are also more likely to leave hospital on their planned discharge date and possibly have a greater chance of finding employment. For psychiatrists, policy makers and health professionals it is important to know that short-stay hospitalisation does not lead to a ‘revolving door’ pattern of admission to hospital and poor or fragmented care. However, all evidence in this review was rated by the review authors to be low quality. More large, well-designed and well-reported trials are justified that focus on important outcomes such as death, self-harm, harm to others, employment, criminal behaviour, mental state, satisfaction with treatment and services, homelessness, social or family relationships and costs. This plain language summary has been written by a consumer Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness.