Symptoms, functioning and quality of life after treatment in a residential sub-acute mental health service in Australia

Abstract

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery-focused, sub-acute service, in Australia. Clients were either step-up clients, entering the service directly from the community, or step-down clients who were transitioning from an inpatient unit to home. During the 30-month period of data collection (August 2011 to January 2014) all clients (N = 102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis-32) and service providers completed the Life Skills Profile-16 and Health of the Nations Outcome Scales. Follow-up data 3 months after exit were available for 12 clients, including the Basis-32 and a self-report measure of quality of life (Assessment of Quality of Life 8-dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self-care, level of symptoms and presence of social problems. At 3 months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub-acute service, step-up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step-down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub-acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital.

Health care utilization and cost after discharge from a mental health hospital; an RCT comparing community residential aftercare and treatment as usual

“…We did not measure change in patients’ level of symptoms and functioning, but two other studies on community residential aftercare have done this [ 21 , 23 ]. An observational study from Australia [ 21 ] found improvement in patients’ symptoms and functioning three months after discharge from the residential inpatient step-down unit.…”

“…We did not measure change in patients’ level of symptoms and functioning, but two other studies on community residential aftercare have done this [ 21 , 23 ]. An observational study from Australia [ 21 ] found improvement in patients’ symptoms and functioning three months after discharge from the residential inpatient step-down unit. An RCT among justice involved persons [ 23 ] found a significant reduction in psychiatric symptom severity after two years in those who had been admitted to self-run community residential aftercare (Oxford House).…”

“…An RCT study on inpatient treatment for substance use disorders compared the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnosis and reported significant reductions in psychiatric severity for those assigned to residential conditions [ 23 ]. An observational study found that a staffed residential step-down facility with a comprehensive program improved symptoms and functioning for persons with psychosis or mood disorder [ 21 ].…”

Similarities and differences in people accessing prevention and recovery care services and inpatient units in Victoria, Australia

“…PARC services, located in the community, offer sub-acute residential care to consumers with serious mental illness who require additional support than would usually be available from community mental health services. They have a strong emphasis on integrating clinical and personal recovery-oriented care, with a commitment to greater consumer involvement and least restrictive practices [1][2][3][4][5][6]. Similar to sub-acute residential services in other states in Australia and in some other high-income countries, PARC services in Victoria play an increasingly important role in the mental health care continuum, supporting consumers to transition from psychiatric inpatient units back into the community (referred to as 'step-down' care) and to prevent or substitute hospitalisation ('step-up' care).…”

Like a hotel, but boring: users’ experience with short-time community-based residential aftercare

“…One solution to these challenges is to discharge patients with SMI, who need community services, to inpatient short-stay in the community in a step-down model with focus on preparing for independent support living. There are examples of residential community units targeting the discharge process [ 23 , 24 ]. These mirrors some of the features suggested for alternative hospital care with small units, normalizing facilities, more flexibility and open door and partnering with the community [ 25 ].…”