The Long-term Outcomes and Unmet Needs of a Cohort of Former Long-Stay Patients in Melbourne, Australia

Abstract

Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent's Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients.

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

“…The period of community residence following discharge to the CCU was consistently reflected on favourably by members of the cohort, although for the majority of individuals this recovery was disrupted following discharge to alternative housing settings. In their more recent experience they identified a lack of somewhere stable to live and broader uncertainty about their future well-being [23]. These findings are mirrored by other studies that document the challenges faced by people without stable housing, in particular the challenge of recurrent dislocation from social supports and the risk of return to institutional care [40].…”

“…In-depth interviews with a cohort of former long-stay patients and CCU residents in Melbourne, Victoria, eight years after hospital discharge, confirmed that patients with persisting severe disabilities may face isolation and dislocation from community supports despite the experience of recovery in some aspects of their lives [23]. The 18 people studied were ageing former long-stay patients discharged from a CCU after several years -on average five years -of residential rehabilitation Members of the cohort reflected on the negative effects of prolonged institutional care, including loss of a social support network and lack of meaningful activities.…”

“…All too often, individuals have to move from one residence to another in order to receive different intensity and types of support and care [23]. As an alternative, many individuals who need support can remain in their own accommodation, according to their preference [92], when appropriate programs are available [93] including adequate family support, and can be adjusted according to need.…”

“…Service systems designed in the context of the closure of long-stay wards need to provide continuity of care for the initial cohort of patients referred to residential services as well as adapting to meet the needs of patients requiring residential rehabilitation who have not had the same history of multiple and protracted admissions to institutions. Introducing throughput of residents in one service component such as a CCU relies on the availability of appropriately supported accommodation options with indefinite tenure to ensure that vulnerable long-term patients receive appropriate continuity of care [23]. There has still been relatively little evaluation of the role of key components of residential rehabilitation, including workforce, and the integration with service systems.…”

“…Across many countries there is a shortage of housing services. There is a risk that the needs of individuals with SMI may be forgotten, particularly those unable to live independently in the community [22,23].…”