A comparison of patient clinical and social outcomes before and after the introduction of an extended-hours community mental health team

Effect of community mental health care programs in Australia: a systematic review

Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.

Longitudinal analysis of statistical and clinically significant psychosocial change following mental health rehabilitation

Purpose: With appropriate mental health rehabilitation, schizophrenia is increasingly associated with reports of recovery and stability. However, there is little empirical evidence evaluating the efficacy of services delivering this care. This study evaluated the effectiveness of rehabilitation for improving psychosocial function in consumers with schizophrenia.Methods: An electronic database of standardized assessment instruments mandated and maintained by the health service was retrospectively reviewed to extract ratings of psychosocial function, daily living skills, and mood state from consecutive admissions to an inpatient rehabilitation service. Outcomes were compared at admission, discharge, and one-year follow-up to identify statistically significant change. Individual reliable and clinically significant change was also assessed by comparison with a normative group of clients functioning independently in the community.Results: From admission to discharge the rehabilitation group made statistically significant gains in psychosocial function and daily living skills. Improvements were reliable and clinically significant in one-quarter to one-third of individual consumers. Approximately half sustained their improvements at follow-up, although this represented only a small fraction of the overall cohort. Consumers not demonstrating gains exhibited psychometric floor effects at admission.Conclusions: Rehabilitation can produce statistically and clinically significant immediate improvement in psychosocial function for a sub-set of consumers with elevated scores at admission. The durability of any gains is less clear, and strategies promoting longer-term maintenance are encouraged. Furthermore, currently mandated outcome measures are confounded by issues of sensitivity and reporting compliance, and exploration of alternative instruments for assessing recovery is recommended.Implications for RehabilitationRoutinely collected standardized outcome measures can be used to investigate the effectiveness of mental health rehabilitationIn addition to statistical significance, the clinical significance of outcomes should be evaluated to identify change that is individually meaningfulCurrently mandated outcomes instruments do not adequately evaluate many individuals' recovery journeyMental health service evaluation and quality improvement processes would likely benefit from adoption of recovery-oriented measures.

Inpatient psychosocial rehabilitation in rural NSW: assessment of clinically significant change for people with severe mental illness

OBJECTIVE

The aim of the present study was to describe an inpatient psychosocial rehabilitation programme in rural New South Wales and to assess the effectiveness of the programme using measures of clinically significant change.

METHOD

The first 88 patients with a schizophrenia spectrum disorder to enter the Manara Clinic and Turon House, New South Wales, psychosocial rehabilitation programmes were assessed at admission and discharge using the Brief Psychiatric Rating Scale, the Health of the Nation Outcome Scales, and the Kessler-10 self-report measure.

RESULTS

Significant improvements in psychiatric symptomatology, psychosocial functioning, and psychological distress were found over the course of the inpatient stay. Clinical significance analyses using patients in the community as the reference group indicated a reliable and clinically significant improvement for 33% of inpatients on psychiatric symptomatology, 39% of inpatients on psychosocial functioning, and 21% of inpatients on psychological distress.

CONCLUSIONS

The psychosocial rehabilitation programme provides clinically significant initial benefits for patients with severe mental illnesses. More attention needs to be paid to evaluating which components of psychosocial rehabilitation contribute most to these benefits. Follow-up evaluation is required to determine whether the benefits of this programme are sustained in the community.