The critical factor: The role of quality in the performance of supported accommodation services for complex mental illness in England

Abstract

Rehabilitation services have a key role in ensuring integrated and comprehensive mental health (MH) care in the community for people suffering from long-term and severe mental disorders. MH-supported accommodation services aim to promote service users’ autonomy and independence. Given the complexity associated with MH-supported accommodation services in England, a comparative evaluation of critical performance indicators, including service provision and quality of care, seems to be necessary in designing evidence-informed policies. This study aims to explore the influence of service quality indicators on the performance of MH-supported accommodation services in England. The analysed sample includes supported accommodation services from 14 nationally representative local authorities in England from the QuEST study grouped by three main types of care: residential care homes (divided into two subgroups: move-on and non-move-on oriented), supported housing and floating outreach. EDeS-MH (efficient decision support-mental health) was used to assess the performance indicators for the selected services by combining a Monte Carlo simulation engine, data envelopment analysis and a fuzzy inference engine for integrating expert knowledge. Depending on the type of care, six/seven quality domains were sequentially included after a baseline scenario (only technical) was analysed. Relative technical efficiency scores for the baseline scenarios revealed high performance in all the selected supported accommodation services, but the statistical variability was high. Quality domains significantly improved performance in every type of care. The inclusion of quality indicators has a positive impact on the global performance of each type of care. Remaining at the corresponding services more than expected for two years has a negative impact on performance. These findings can be considered from a planning perspective to facilitate the design of pathways of care with more realistic expectations about gaining autonomy in two years.

Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland)

“…There has been a transfer of inpatients to residential community care in Helsinki-Uusimaa. This transfer would require an in-depth longitudinal analysis of the pathways of care and the quality of care provision in the non-hospital sector to fully understand whether this process is related to trans-institutionalization or to balance supported accommodation, as described and analysed in England [ 36 ].…”

“…Efficient community-based managerial models for MH ecosystems have been previously described in the Basque Country (Spain) [ 55 , 56 ] and in England [ 36 ]. However, due to the differences in the Finnish framework, specific tailor-made interventions and policies are required to obtain a positive outcome [ 53 ].…”

“…[ 57 , 58 ]. This approach would enable a broader examination of the Finnish MH care system’s performance, similar to those conducted in England (supported accommodation services) [ 36 ].…”

“…These specific patterns of use are very relevant to assuring the comparability of the sample. Taking into account that DESDE-LTC codes (types of care) are based on the service activities, sometimes specific managerial nuances can be hidden [ 36 ]. The resulting information of the regression analysis is then used in technical performance assessment by taking into account potential subsets and formalizing knowledge to carry out the “interpretation of variable values” process.…”