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Parker S, Chapman M, Wyder M, Pommeranz M, Walgers R, Dark F, Meurk C. Life is better but not without challenges: experiences following discharge from community-based residential mental health rehabilitation-a qualitative content analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02716-z. [PMID: 39012385 DOI: 10.1007/s00127-024-02716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Community-based residential mental health rehabilitation units for people experiencing severe and persistent mental illness are increasingly available in Australia. Research completed 20 years ago suggested that people leaving these services often experienced impoverished social lives and other challenges in the community. It is unclear whether contemporary consumers experience similar difficulties. This qualitative study explored contemporary consumers' experiences after leaving community-based residential services. METHODS An inductive qualitative content analysis of individual interviews was completed with consumers 12-18 months following discharge from three community care units (CCUs) in Queensland, Australia. The interview schedule explored three questions: (1) What does life look like after leaving the CCU, (2) Has the CCU impacted their life, and (3) How could the CCU experience be improved? A convenience sample was used, with sampling continuing until thematic saturation was achieved. A member of the research team who had relevant lived experience actively supported the analysis and interpretation. RESULTS Seventeen interviews were completed. Three themes were identified: 'life is better but not without challenges', 'the CCU helps you get ready to go out into the world', and 'strict rules are important but rigid expectations can be hard; things could be better'. CONCLUSION Consumers reflected positively on their lives post-discharge from a community-based residential rehabilitation unit and viewed the service as having supported improvements in their lives. The findings suggest the appropriateness of optimism about the possibility of sustained improvements in quality of life after leaving community-based transitional residential rehabilitation support.
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Affiliation(s)
- Stephen Parker
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia.
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia.
- Metro North Mental Health, The Prince Charles Hospital, Chermside, QLD, Australia.
- Metro North Mental Health, Royal Brisbane & Womens Hospital, Herston, QLD, 4006, Australia.
| | - Maddison Chapman
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Marianne Wyder
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Matthew Pommeranz
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Rebecca Walgers
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Woolloongabba, QLD, Australia
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia
| | - Carla Meurk
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, QLD, Australia
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Santos Martins F, Feldens T, Guerra C, Santos JV. Long-term mental health care in Portugal: A portrait of the first years of activity. Int J Soc Psychiatry 2023; 69:1605-1616. [PMID: 37092774 DOI: 10.1177/00207640231168026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION In Portugal, a reform to implement Long-term mental health care (LTMHC) started in 2017 allowing patients with severe mental illness receiving psychosocial rehabilitation to regain their autonomy and be reintegrated into their communities. AIM To describe the first steps of the Portuguese LTMHC implementation and to assess the relationship between the LTMHC's demand (referrals) and supply (vacancies and occupancy). METHODS We conducted a national retrospective observational study to analyse the LTMHC referrals, vacancies and occupancy between mid-2017 (LTMHC establishment) and December 2022. We described and analysed the associated indicators through time and geography, as well as performed a simultaneous regression model to evaluate the relationship between supply and demand. RESULTS There were 1,192 referrals to the LTMHC, of which 99 (8.3%) were made for childhood and adolescence structures. The maximum support residence (RAMa, 'Residência de apoio máximo'), designed for patients with higher disabilities, had the highest number of referrals. Additionally, since the opening of vacancies in different institutions, residential structures became quickly saturated. On the other hand, domiciliary services were those with the lowest occupancy. Our estimates support that the vacancies (supply) are induced by the referrals (demand), and referrals are also related to the location of LTMHC facilities. CONCLUSION LTMHC is still in the initial stage of development in Portugal, and it is expected to receive financial support through the Recovery and Resilience Programme. According to the occupancy rates and referrals made, residential structures seem to be a priority, being also important to explore the partial use of domiciliary services. The geographical distribution of vacancies can also be a concern, considering the important proximity to the community in LTMHC.
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Affiliation(s)
- Filipa Santos Martins
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Tallys Feldens
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- Federal University of Paraná, Paraná, Brazil
| | - Cátia Guerra
- Psychiatry and Mental Health Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - João Vasco Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Public Health Unit, ACES Grande Porto V - Porto Ocidental, Porto, Portugal
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Adamus C, Alpiger J, Jäger M, Richter D, Mötteli S. Independent Supported Housing Versus Institutionalised Residential Rehabilitation for Individuals with Severe Mental Illness: A Survey of Attitudes and Working Conditions Among Mental Healthcare Professionals. Community Ment Health J 2023; 59:531-539. [PMID: 36227518 PMCID: PMC9981490 DOI: 10.1007/s10597-022-01037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/03/2022]
Abstract
Despite widespread support for Independent Supported Housing (ISH) interventions, psychiatric housing rehabilitation still commonly takes place in residential care facilities (RCFs). This study compares preferences, attitudes and working conditions of mental healthcare professionals (MHCPs) in ISH and RCFs using an online survey. The survey included setting preferences, stress and strain at work, recovery attitudes, stigmatisation, and factors experienced as particularly important or obstructive in housing rehabilitation. Data were analysed using quantitative and qualitative approaches. Of the 112 participating MHCPs, 37% worked in ISH and 63% in RCFs. Professionals' education, work-related demands and influence at work were higher in ISH, stigmatising attitudes were higher in RCFs. MHCPs in both settings endorsed ISH. The support process was seen as particularly important whereas stigmatisation, regulatory and political requirements were seen as obstructive for successful housing rehabilitation. Results indicate that social inclusion of individuals with severe mental illness is seldom feasible without professional support.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland. .,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. .,Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, 3098, Köniz, Switzerland.
| | - Jovin Alpiger
- School of Applied Psychology, ZHAW Zurich University of Applied Sciences, Zurich, Switzerland
| | - Matthias Jäger
- Psychiatrie Baselland, Liestal, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Dehn LB, Driessen M, Steinhart I, Beblo T. Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study. Front Psychiatry 2022; 13:834389. [PMID: 35185660 PMCID: PMC8854761 DOI: 10.3389/fpsyt.2022.834389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience. METHODS Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics. RESULTS To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies. CONCLUSIONS The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.
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Affiliation(s)
- Lorenz B Dehn
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.,Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Ingmar Steinhart
- von Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany.,Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e. V., University of Greifswald, Greifswald, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelische Klinikum Bethel, Universitätsklinikum OWL of Bielefeld University, Bielefeld, Germany.,Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Supported Housing for non-homeless individuals with severe mental illness: Comparison of two effectiveness studies using a randomised controlled and an observational study design. Front Psychiatry 2022; 13:1033328. [PMID: 36440393 PMCID: PMC9685807 DOI: 10.3389/fpsyt.2022.1033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field. METHODS A two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms. RESULTS The study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [-0.08 to 13.35]) and the OS (2.24 [-2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [-0.52 to 0.75]; OS: 0.16 [-0.26 to 0.58]) and symptoms (RCT: -0.18 [-0.75 to 0.40]; OS: 0.21 [-0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants' willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable. CONCLUSION Participants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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