The relationship between community-based psychiatric rehabilitation pathways and re-hospitalization trajectories: A three-decade follow-up

•The usage of psychiatric rehabilitation services (PRS) for people with schizophrenia was associated with double time-to-readmission.•People who used PRS (any kind) had lower mean annual rehospitalization days.•More intensive residential services were associated with larger reductions in re-hospitalization days.•Supported employment and sheltered workshops were the vocational services associated with the largest decrease in re-hospitalization days.•Providing both vocational and residential PRS had a synergistic effect on the reduction of re-hospitalization days. Psychiatric rehabilitation is essential for the recovery of individuals with schizophrenia. However, re-hospitalization is sometimes inevitable. This study examined the association between varied community psychiatric rehabilitation services (PRS) and long-term re-hospitalization parameters. National registries provided data on 5163 adults diagnosed with schizophrenia and schizoaffective disorder. Patients with recurrent hospitalizations were tracked over three periods: before rehabilitation legislation (1991–2000), during rehabilitation implementation (2001–2009), and follow-up (2010–2017). Associations between PRS types and annual re-hospitalization days (ARHD) during follow-up were analyzed. Findings revealed that the rehabilitation group had a median time-to-readmission of 757 days, while the non-rehabilitation group had 321 days. Combined residential and vocational rehabilitation was associated with a 20-day decrease in ARHD, while residential or vocational rehabilitation alone were associated with reductions of 2 and 5 days, respectively. Higher levels of residential support were linked to reduced ARHD. Of the vocational rehabilitation types, supported-employment and sheltered-workshops showed association with the greatest reductions in ARHD (17 days). Overall, community-based PRS is linked to prolonged time-to-readmission and reduced re-hospitalization days. A combination of vocational and residential services is related to a synergistic decrease in re-hospitalization days. This suggests that recurrent hospitalization for patients who are using PRS is shorter and may be part of their recovery pathway.