Continuing Accommodation and Support Needs of Long-Term Patients with Severe Mental Illness in the Era of Community Care

Chopra, Prem; Harvey, Carol; Herrman, Helen

doi:10.2174/157340011795945801

Cited by 8 publications

(6 citation statements)

References 113 publications

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Section: Comparison Between Locked and Open Unitscontrasting

confidence: 79%

“…They may reflect differences between the groups in each unit, or differences in climate between the relatively new locked unit and the longer-established open units. However, within this sample, findings refute claims that secure settings are at odds with recovery principles (Chopra et al, 2011). Conversely, it appeared that the locked unit was seen by both service users and staff as being committed to promoting meaningful activities, choice and fostering hope.…”

Section: Comparison Between Locked and Open Unitscontrasting

confidence: 77%

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The recovery-orientation of three mental health units

Bass

Tickle

Lewis

2014

Mental Health Review Journal

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Purpose -The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two "open" and one "locked". It identified elements of recovery that were important to service users. It measured the units' performance on domains of recovery, attending to differences between staff members' and service users' perceptions and between the locked and open units. Design/methodology/approach -A cross-sectional design was used. Staff and service users completed the "Developing Recovery Enhancing Environment Measure (DREEM)". Findings -Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users' responses highlighted potential areas for service improvement.Research limitations/implications -The sample was small but reflected the applied setting. Some service users were not invited to participate because of significant communication or cognitive difficulties and it is recognised that they may have had alternative views that remain unrepresented. Practical implications -The DREEM provided valuable information about current practice and potential for service development. Both locked and open units can provide recovery-oriented environments. Services should be aware of discrepant views between staff and service users. Originality/value -To the knowledge, this is the first study to use the DREEM to evaluate the recovery orientation of a locked recovery unit and to compare locked and unlocked units.

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Section: Comparison Between Locked and Open Unitscontrasting

confidence: 79%

Section: Comparison Between Locked and Open Unitscontrasting

confidence: 77%

The recovery-orientation of three mental health units

Bass

Tickle

Lewis

2014

Mental Health Review Journal

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“…A conceptual limitation of the study is the emphasis on the CCU and it staff as a key consideration in the outcomes of people with a diagnosis of serious and persistent mental illness. The factors impacting on entry to, exit from and the outcomes of rehabilitation care are likely multifactorial and dependent on resources and supports external to the unit [ 74 ]. Considerations in the socio-economic environment include the availability of housing, employment and welfare opportunities; funding of external clinical and non-clinical services, and broader issues relating to social and structural stigma impacting functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives

et al. 2016

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BackgroundA novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives.Methods/designThe longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with collection of data from consumers and staff at multiple time points exploring their expectations, experiences and reflections on the care provided by these services.DiscussionIt is expected that the new knowledge gained through this study will guide the adaptation of these and similar services. For example, if differential outcomes are achieved for consumers under the integrated and clinical staffing models this may inform staffing guidelines.

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“…Community Rehabilitation Units emerged in the context of de-institutionalisation. The initial goal was to assist long-stay inpatients in returning to community living in an appropriately supported ‘home-like’ environment [5]. Community Rehabilitation Units are now typically transitional in focus, aiming to help consumers to reside in more independent living situations by the time of discharge.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of service models and evidence relating to the clinically operated community-based residential mental health rehabilitation for adults with severe and persisting mental illness in Australia

et al. 2019

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BackgroundClinically operated community-based residential rehabilitation units (Community Rehabilitation Units) are resource intensive services supporting a small proportion of the people with severe and persisting mental illness who experience difficulties living in the community. Most consumers who engage with these services will be diagnosed with schizophrenia or a related disorder. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers’ service experiences and outcomes.MethodA systematic review was undertaken to identify studies describing Community Rehabilitation Units in Australia, consumer characteristics, and evidence about consumer experiences and outcomes. Search strings were applied to multiple databases; additional records were identified through snowballing. Records presenting unique empirical research were subject to quality appraisal.ResultsThe typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach. Key differentiating features were the focus on transitional care and ‘recovery’ under TRR. Schizophrenia spectrum disorders were the most common primary diagnosis under both service types. TRR consumers were more likely to be male, referred from community settings, and less likely to be subject to involuntary treatment. Regarding outcomes, the limited quantitative evidence (4 records, 2 poor quality) indicated C-BRC was successful in supporting the majority of consumers transferred from long-term inpatient care to remain out of hospital. All qualitative research conducted in C-BRC settings was assessed to be of poor quality (3 records). No methodologically sound quantitative evidence on the outcomes of TRR was identified. Qualitative research undertaken in these settings was of mixed quality (9 records), and the four records exploring consumer perspectives identified them as valuing the service provided.ConclusionsWhile there is qualitative evidence to suggest consumers value the support provided by Community Rehabilitation Units, there is an absence of methodologically sound quantitative research about the consumer outcomes achieved by these services. Given the ongoing and increasing investment in these facilities within the Australian context, there is an urgent need for high-quality research examining their efficiency and effectiveness.Trial registrationPROSPERO (CRD42018097326).Electronic supplementary materialThe online version of this article (10.1186/s12888-019-2019-5) contains supplementary material, which is available to authorized users.

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Continuing Accommodation and Support Needs of Long-Term Patients with Severe Mental Illness in the Era of Community Care

Cited by 8 publications

References 113 publications

The recovery-orientation of three mental health units

The recovery-orientation of three mental health units

Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives

A systematic review of service models and evidence relating to the clinically operated community-based residential mental health rehabilitation for adults with severe and persisting mental illness in Australia

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