Residential alternatives to acute psychiatric hospital admission: systematic review

Lloyd‐Evans, Brynmor; Slade, Mike; Jagielska, Dorota

doi:10.1192/bjp.bp.108.058347

Cited by 72 publications

(80 citation statements)

References 42 publications

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“…Previous studies have found higher satisfaction amongst crisis house service users than those on acute wards [12], [17], but have not produced quantitative evidence for potential explanatory mechanisms. We have generated such evidence.…”

Section: Discussionmentioning

confidence: 85%

“…Despite a long history (which dates back at least to the 1960s), there is little robust research examining crisis houses. However, a recent systematic review of predominantly American literature found that service user satisfaction is greater in crisis residential alternatives than on inpatient wards [12] with some research evidence that the quality of staff-service user relationships is enhanced [13].…”

Section: Introductionmentioning

confidence: 99%

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The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Sweeney¹,

Fahmy²,

Nolan

et al. 2014

PLoS ONE

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BackgroundPoor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.Methods and FindingsMixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.ResultsWe found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.Conclusions and ImplicationsWe found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Sweeney¹,

Fahmy²,

Nolan

et al. 2014

PLoS ONE

Self Cite

View full text Add to dashboard Cite

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“…70 Third, we should reduce or even eliminate institutional structures based on outdated models of care (including psychiatric hospitals and day treatment centres), given that research indicates that alternatives can be more effective and humane. 71 The money saved can be used to provide community supports and supported housing that is decent, affordable, and safe. Fourth, we would need to educate a new type of clinician and create renewed clinical systems that emphasize respect, alliance, freedom, choice, selfmanagement, peer support, and facility with behavioural health technology.…”

Section: Health Servicesmentioning

confidence: 99%

Recovery and Severe Mental Illness: Description and Analysis

2014

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The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system.

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“…Studies of recovery-oriented staff training in community-based settings have shown positive changes in staff attitudes (9). Evaluations of the recovery-orientation of mental health services have focused on outpatient and rehabilitative facilities rather than inpatient facilities (10,11). Moreover, the recovery-orientation among staff in psychiatric hospitals appears to be lower than that in community settings (12,13).…”

Section: Introductionmentioning

confidence: 99%

Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

Jaeger¹,

Konrad

Rueegg

et al. 2014

Nordic Journal of Psychiatry

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Background : Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. Aim : This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. Methods : During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n 34 and n 29) were compared with regard to subjective parameters (e.g. patients ' attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). Results: Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. Conclusions: The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery.

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Residential alternatives to acute psychiatric hospital admission: systematic review

Cited by 72 publications

References 42 publications

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Recovery and Severe Mental Illness: Description and Analysis

Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

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