In-patient psychiatric rehabilitation services: survey of service users in three metropolitan boroughs

Abstract

Aims and methodTo examine care pathways and characteristics of service users across a range of in-patient rehabilitation settings: community, long-term complex care and high-dependency rehabilitation.ResultsSignificant differences were found for service users in the different units with respect to duration of stay, length of history, number of admissions, community team, physical health, social functioning, history of aggression and perceived risk if discharged.Clinical implicationsCommunity service provision may not adequately meet the needs of the most disabled and access to appropriate move-on facilities for rehabilitation in-patients is insufficient. Remedying this requires collaboration between policy makers, commissioners and clinicians to ensure access to a comprehensive range of services.

In-patient rehabilitation: clinical outcomes and cost implications

“…Killaspy et al 11 showed that older patient age was significantly associated with worse outcomes. This national survey identified delayed discharges in 14% of rehabilitation patients, whereas a lack of suitable move-on accommodation – particularly from lower intensity community units – was noted in another, ten-unit survey by Cowan et al : 17 over half of the patients had no clear community team follow-up. A lack of appropriate follow-up for those with high levels of disability, a quarter of whom ended up under the care of assertive outreach teams, was identified as a gap.…”

“…Rehabilitation might be relatively ‘unfashionable’, 3 but if this is the case then the rehabilitation psychiatry subspecialty must accept some responsibility for this. Rehabilitation has historically been an under-researched branch of mental health, 4 , 17 despite the cost of such services 21 and the obvious challenge of severe and enduring mental distress. 22 , 23 Killaspy et al 's 4 description of the field as an ‘evidence free zone’ remains, if no longer wholly accurate, nevertheless still apposite a decade after the statement was made.…”

Patient engagement and problematic behaviours in nurse-staffed residential rehabilitation units

“…The limited progress to greater independence observed in this group 9 does not simply reflect a more severe form of treatment-resistant illness but also the consequences of poor engagement and problem behaviours. Routinely assessing engagement and problematic behaviours, alongside the success of any interventions, may usefully help to determine the need for longer-term intensive support or potential for discharge.…”

“…Alongside other issues, such as the availability of suitable community alternatives, 3 this in part explains why patients in this sample had not yet moved on. 9 A comparison of the lifetime and 6-month data suggest that problematic behaviours may have reduced, pointing to the benefit of these services (especially those in high-dependency units) in providing the necessary supervision and containment to manage risks. However, a lack of willingness to discuss symptoms and behaviours makes it likely that patients may well not have grasped the factors driving problematic behaviours.…”

“…A cross-sectional survey of patients in units provided by two National Health Service mental health trusts (covering a population of approximately 1.5 million across the three boroughs of Birmingham, Solihull and Sandwell within the West Midlands) was undertaken to examine care pathways and patient characteristics. 9 The units were categorised as community rehabilitation, longer-term complex care and high-dependency, in accordance with the definitions adopted by the Royal College of Psychiatrists. 4…”