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Sambrook L, Balmer A, Roks H, Tait J, Ashley-Mudie P, McIntyre JC, Shetty A, Bu C, Nathan R, Saini P. The journey of service users with complex mental health needs: a qualitative study. Health Psychol Behav Med 2024; 12:2365226. [PMID: 38887740 PMCID: PMC11182059 DOI: 10.1080/21642850.2024.2365226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Background: This study aimed to provide a robust picture of the journey of service users with complex mental health needs by evaluating the perspectives of service users and carers with lived experience of services and gaining clinician views about decision making in relation to this cohort. Methods: A qualitative design was used. Service users (n = 11), carers (n = 10) and clinicians (n = 18) took part in semi-structured interviews, which were transcribed verbatim and analysed using thematic analysis. Results: The following themes were identified by participants: 'relationships with staff,' 'treatment options, pathways and availability,' 'the role of autonomy in recovery,' 'impact of out-of-area placements,' and 'specialist training for staff.' The findings demonstrated that the journey of serviceusers can be impacted by a wide range of factors, including relationships with staff, the nature of support offered, community response, financial constraints, and organisational goals around bed pressures. Conclusions: Recommendations include the need for staff to work in partnership with service users and carers, foster autonomy, access specialised suicide prevention training, and agree discharge and contingency plans with service users. Further work is needed to deliver the best possible experience for individuals with complex mental health needs and those who care for them.
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Affiliation(s)
- Laura Sambrook
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Anna Balmer
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Hana Roks
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Jackie Tait
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | | | - Amrith Shetty
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Christopher Bu
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Eager S, Killaspy H, C J, Mezey G, McPherson P, Downey M, Thompson G, Lloyd-Evans B. A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study. Interact J Med Res 2024; 13:e45987. [PMID: 38477978 DOI: 10.2196/45987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 12/08/2023] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. OBJECTIVE This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. METHODS This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. RESULTS Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. CONCLUSIONS The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.
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Affiliation(s)
- Sharon Eager
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Joanna C
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gillian Mezey
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Megan Downey
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Georgina Thompson
- Division of Psychiatry, University College London, London, United Kingdom
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3
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Waks S, Morrisroe E, Reece J, Fossey E, Brophy L, Fletcher J. Consumers lived experiences and satisfaction with sub-acute mental health residential services. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02631-3. [PMID: 38456931 DOI: 10.1007/s00127-024-02631-3] [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: 09/11/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Sub-acute recovery-oriented facilities offer short-term residential support for people living with mental illness. They are generally highly regarded by consumers, with emerging evidence indicating that these services may support recovery. The aim of the current study was to explore the relationship between personal recovery and consumers' satisfaction with sub-acute residential services, and consumers' views about service features that aid recovery. METHODS Consumers at 19 adult Prevention and Recovery Care Services in Victoria, Australia, were invited to complete measures containing sociodemographic information and measures on personal recovery and wellbeing. After going home, participants were invited to complete measures on service satisfaction and experience. RESULTS Total and intrapersonal scores on the personal recovery measure increased significantly between Time 1 and Time 2, indicating marked improvement. Personal recovery and satisfaction measures were moderately to strongly correlated. Thematically analysed open-ended responses revealed themes of feeling connected, finding meaning and purpose, and self-empowerment as important aspects of these services, with some recommendations for improvements. CONCLUSION Sub-acute residential mental health care may support individuals' personal recovery; consumer satisfaction indicates these services also offer an acceptable and supportive environment for the provision of recovery-oriented care. Further exploring consumers' experiences of sub-acute residential services is essential to understand their effectiveness, opportunities for improvement and intended impacts on personal recovery.
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Affiliation(s)
- S Waks
- Discipline of Clinical Psychology, Graduate Schools of Health, University of Technology Sydney, Chippendale, NSW, Australia
| | - E Morrisroe
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J Reece
- Discipline of Psychological Science, Australian College of Applied Professions, Melbourne, VIC, Australia
| | - E Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - L Brophy
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia.
- Social Work & Social Policy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - J Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, VIC, Australia
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4
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Brolin R, Tjörnstrand C, Friis M, Argentzell E, Bejerholm U, Eklund M, Brunt D. "It's not just the residents who need to be motivated for activity": a qualitative study of the perspectives of staff on providing activity support for people with psychiatric disabilities in supported housing in Sweden. Front Psychiatry 2024; 14:1322859. [PMID: 38250283 PMCID: PMC10797039 DOI: 10.3389/fpsyt.2023.1322859] [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: 10/16/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Background The goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents' independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations. Objective The aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities. Methods Twenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis. Results Three main categories emerged from the analysis: Multi-faceted factors influencing the staff's provision of activity support, Staff's approach for supporting activities, and Staff's struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff's ability to motivate to activity. Conclusion A broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing.
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Affiliation(s)
- Rosita Brolin
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Tjörnstrand
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Mette Friis
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Mona Eklund
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - David Brunt
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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5
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Markström U, Näslund H, Schön UK, Rosenberg D, Bejerholm U, Gustavsson A, Jansson M, Argentzell E, Grim K, Engdahl P, Nouf F, Lilliehorn S, Svedberg P. Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol. Front Psychiatry 2023; 14:1282700. [PMID: 37900294 PMCID: PMC10601639 DOI: 10.3389/fpsyt.2023.1282700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.
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Affiliation(s)
| | - Hilda Näslund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | | | | | - Mårten Jansson
- The Swedish Partnership for Mental Health, NSPH, Stockholm, Sweden
| | | | - Katarina Grim
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Patrik Engdahl
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Faten Nouf
- Department of Social Work, Umeå University, Umeå, Sweden
| | | | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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6
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Eager S, Killaspy H, C J, Mezey G, Downey M, Lloyd-Evans B. Understanding the social inclusion needs of people living in mental health supported accommodation. BMC Res Notes 2023; 16:156. [PMID: 37491405 PMCID: PMC10369760 DOI: 10.1186/s13104-023-06428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES To identify the social inclusion needs that were (i) most commonly identified and (ii) most and least commonly prioritised as support planning goals for mental health service users living in supported accommodation, using the online Social Inclusion Questionnaire User Experience (SInQUE). We qualitatively examined mental health supported accommodation staff and servicer users' views on barriers to offering support with two less commonly prioritised areas: help finding a partner and feeling less lonely. METHODS Anonymous SInQUE data were collected during a completed study in which we developed and tested the online SInQUE. Four focus groups were conducted with mental health supported accommodation staff (N = 2) and service users (N = 2). RESULTS The most common social inclusion needs identified by service users (N = 31) were leisure activities, finding transport options, and feeling less lonely. Of the needs identified, those that service users and staff least frequently prioritised as support planning goals were having company at mealtimes, getting one's own furniture, feeling less lonely, help with finances, and help finding a partner. In the focus groups, staff and service users identified barriers to helping with loneliness and finding a partner which related to staff and service users themselves, supported accommodation services, and wider societal factors.
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Affiliation(s)
- Sharon Eager
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Helen Killaspy
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Joanna C
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gillian Mezey
- St George's, Population Health Research Institute, University of London, London, UK
| | - Megan Downey
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, UK.
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7
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. What are important ingredients for Intensive Home Support for people with severe mental illness according to experts? A concept mapping approach. BMC Psychiatry 2023; 23:475. [PMID: 37380952 DOI: 10.1186/s12888-023-04975-7] [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: 01/30/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Deinstitutionalization in mental health care has been an ongoing process for decades. More and more people with severe mental illness (SMI), who previously lived in residential supported housing settings and were formerly homeless, are now living independently in the community but need intensive support to enable independent living. The support provided by regular outpatient teams is inadequate for this target group. This study explored the ingredients for an alternative form of outpatient support: intensive home support (IHS). METHODS Concept mapping was used, following five steps: (1) brainstorming, (2) sorting, (3) rating, (4) statistical analysis & visual representation, and (5) interpretation. Purposive sampling was used to represent several perspectives, including researchers, professionals, peer workers, and policy makers. RESULTS Experts (n = 17) participated in the brainstorming step and the sorting and rating steps (n = 14). The 84 generated statements were grouped into 10 clusters:. (1) housing rights; (2) informal collaboration; (3) reciprocity in the community; (4) normalization and citizenship; (5) recovery; (6) sustainable funding; (7) equivalence; (8) flexible, proactive 24/7 support; (9) public health and positive health; and (10) integrated cooperation in support at home. CONCLUSIONS Given the diversity of the ingredients contained in the clusters, it seems that IHS should be designed according to a holistic approach in collaboration with several sectors. Additionally, IHS is not only the responsibility of care organizations but also the responsibility of national and local governments. Further research about collaboration and integrated care is needed to determine how to implement all of the ingredients in practice.
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Affiliation(s)
- Caroline van Genk
- Tranzo Scientific Center for Care and Wellbeing, School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - Diana Roeg
- Tranzo Scientific Center for Care and Wellbeing, School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, The Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, The Netherlands
- HVO-Querido, Amsterdam, The Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Tine Van Regenmortel
- Tranzo Scientific Center for Care and Wellbeing, School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Faculty of Social Sciences - HIVA, University of Leuven, Leuven, Belgium
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8
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Harrison M, Forsyth K, Murray AL, Angarola R, Henderson S, Irvine Fitzpatrick L, Fisher G. Establishing the measurement properties of the Residential Environment Impact Scale (Version 4.0). Scand J Occup Ther 2022:1-10. [PMID: 36490204 DOI: 10.1080/11038128.2022.2143891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Developed as an environment assessment informed by the Model of Human Occupation, the Residential Environment Impact Survey considered the physical, social and activity features of the environment, evaluating the impact of the environment on resident's quality of life. Clinicians reported that the Residential Environment Impact Survey was a useful tool; however, it had not been structured to be a measurement tool and did not have established psychometric properties. AIMS/OBJECTIVES This study examines the psychometric properties of the restructured Residential Environment Impact Scale Version 4.0 (REIS), which measures the level of environment support provided to residents. MATERIAL AND METHODS The REIS was completed across residential sites for people with complex mental health needs. A many facets Rasch analysis was conducted to establish the reliability and validity of the REIS. RESULTS The REIS demonstrated reasonable psychometric properties, with items demonstrating internal scale validity and scale items following an expected pattern of increasingly challenging environment support. CONCLUSIONS AND SIGNIFICANCE Initial evidence suggests that the REIS provides a valid and reliable measure of environment support, providing a detailed assessment of how physical, social and activity elements of the environment support or inhibit participation and can be applied across a range of living environments.
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Affiliation(s)
- Michele Harrison
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - Aja Louise Murray
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland.,School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Rocco Angarola
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland.,Midlothian Health and Social Care Partnership, Dalkeith, Scotland
| | - Shona Henderson
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | | | - Gail Fisher
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, IL, USA
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9
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Martinelli A, Killaspy H, Zarbo C, Agosta S, Casiraghi L, Zamparini M, Starace F, Rocchetti M, de Girolamo G, Ruggeri M, Boero ME, Cerveri G, Clerici M, D’Anna G, De Novellis A, Di Michele V, Di Prisco P, Durbano F, Facchini F, Ghio L, Giosuè P, Greco C, Latorre V, Leuci E, Malagamba D, Maone A, Marina M, Maurizi A, Monzani E, Placenti R, Rancati L, Rippa A, Rovera C, Silva A, Tura G, Zanolini S. Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders. BMC Psychiatry 2022; 22:717. [PMID: 36397009 PMCID: PMC9672559 DOI: 10.1186/s12888-022-04344-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. METHODS Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. RESULTS Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. CONCLUSIONS Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.
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Affiliation(s)
- Alessandra Martinelli
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy. .,Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, BS, Italy.
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Cristina Zarbo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sara Agosta
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy ,Clinical Psychology Unit, ASST of Mantua, Mantua, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Manuel Zamparini
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Fabrizio Starace
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Giovanni de Girolamo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mirella Ruggeri
- grid.411475.20000 0004 1756 948XSection of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
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10
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Pedrosa B, Cardoso G, Azeredo-Lopes S, Aluh D, Grigaitė U, Dias M, Silva M, Caldas de Almeida J. Experiences of care perceived by users of supported accommodations for people with serious mental disorders: Can they impact quality of life? Int J Soc Psychiatry 2022; 69:626-638. [PMID: 36300907 DOI: 10.1177/00207640221127928] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND To understand if supported accommodations (SA) are promoting the recovery of people with serious mental disorders, quality of life (QoL) is an important outcome. This study aimed to analyse the association between QoL and experiences of care in general and to identify specific experiences of care that are associated with QoL in users of SA. METHODS A random sample of users of 42 SA was interviewed to obtain standardized measures of QoL and personal experiences of care. The sample was also characterized according to sociodemographic and clinical aspects. Linear regressions models analysed the association between QoL and experiences of care, adjusting for potential confounders. Results include estimated regression coefficients, corresponding 95% confidence intervals and p-values. RESULTS The number of users interviewed was 272. The median QoL was 4.9 (2.3-6.8) out of 7. Although 84.9% of users were satisfied with the care received, only 16.2% felt involved in their treatment. Feeling safe (β = .73; 95% CI [0.22-1.24], p = .006) and having privacy (β = .42; 95% CI [0.09-0.75], p = .014) influenced QoL. Involvement in care (β = .44; 95% CI [0.13-0.74], p = .006), safety and privacy (β = .72; 95% CI [0.44-0.99], p = 8.38e-07) and user-professional relationship (β = .42; 95% CI [0.14-0.69], p = .003) were also associated with QoL. CONCLUSIONS Feeling safe, having privacy, feeling involved in care and having good user-professional relationships influence the QoL of users. These findings have implications from the political and economic level to the organizational and individual levels.
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Affiliation(s)
- Bárbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
| | - Sofia Azeredo-Lopes
- Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal.,Department of Statistics and Operational Research, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Deborah Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal.,Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
| | - José Caldas de Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa; Lisboa, Portugal
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11
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Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
Background The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. Objective This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. Methods We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions. Results The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. Conclusions We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
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Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia.,Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia.,Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
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12
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Jose AL, Harrison M, Roy AS, Fitzpatrick LI, Forsyth K. The level of formal support received by people with severe mental illness living in supported accommodation and participation: A systematic review. Int J Soc Psychiatry 2021; 67:854-866. [PMID: 33487055 PMCID: PMC8559179 DOI: 10.1177/0020764020988576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The review aimed to identify and explore the association of level of support received by people with severe mental illness in supported accommodation and participation. METHOD The authors conducted a systematic search in MEDLINE, PsychINFO, PsychARTICLES, CINAHL Plus and ASSIA. Searches were restricted to articles published in English and participants aged 18 years and over with severe mental illness. Articles were included based on level of support received in mental health supported accommodation, classified according to the Simple Taxonomy for Supported Accommodation, and three factors of participation: social participation, daily living functioning and personal empowerment. Studies of in-patient settings and nursing homes were excluded. The review protocol is registered on PROSPERO (registration number: CRD42019161808). RESULTS Six articles were included in the review from USA, Australia, Sweden and Taiwan. Factors of participation for people living in accommodation with moderate support and accommodation with high support were explored. Data indicated an association between level of support and participation showing that people living in accommodation with moderate support had increased participation compared to people living in accommodation with high support. CONCLUSION This review identified an association between level of formal support and participation. People with SMI living in accommodation with medium support participated in more community occupations, more activities and had a higher level of personal empowerment than people living in accommodation with high support.
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Affiliation(s)
- Akkara Lionel Jose
- School of Health Sciences, Queen
Margaret University, Queen Margaret University Drive, Edinburgh, UK
| | - Michele Harrison
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
| | - Anusua Singh Roy
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
| | - Linda Irvine- Fitzpatrick
- Strategic Programme Manager, Mental
Health and Wellbeing, City of Edinburgh Health and Social Care Partnership,
Edinburgh, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
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13
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Lindvig GR, Topor A, Bøe TD, Larsen IB. "I will never forget him". A qualitative exploration of staff descriptions of helpful relationships in supportive housing. J Psychiatr Ment Health Nurs 2021; 28:326-334. [PMID: 32657471 DOI: 10.1111/jpm.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented studies show that the quality of the professional relationship plays an essential role in the recovery from mental illness. Within mental health care in general, previous studies show that helpful professional relationships are characterized by several reciprocal aspects, such as friendship resemblance and self-disclosure. The literature is scarce on in-depth explorations of professional relationships within the often long-lasting and intimate help context of institutional supportive housing. Explorations of staff members' experiences are absent. The scientific rationale of this study was to expand the current knowledge about professional relationships in mental health care by exploring staff members' descriptions of helpful professional relationships in supportive housing institutions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: The study shows that helpful relationships may involve staff experiences of reciprocity in terms of both a two-way influence between staff and residents and a reciprocal gain from being part of the helpful relationships. A conceptualization of reciprocity that complements existing concepts is suggested and connected to a "good match" between staff and residents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When support and care are intended to be provided within a dyadic relationship, both parties' preferences should be considered when pairing service users and professionals. Practitioners should get involved in ways that open up for being influenced and inspired by the service user's characteristics, such as personality and attitude. Furthermore, they should dare to enjoy and make use of the company of the service user in ways that promote multifaceted reciprocity. ABSTRACT: Introduction In the aftermath of the deinstitutionalization in western countries, new community-based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community-based institutional supportive housing. Aim To explore how staff members describe their relationships with residents who have identified them as helpful. Methods Qualitative interviews with nine staff members were analysed using thematic analysis. Results "Reciprocity" was identified as the main theme, and two subthemes were developed: "Something influential about the resident" and "Value for the staff member." Discussion The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested. Implications for practice To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity.
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Affiliation(s)
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway.,Department of Social work, University of Stockholm, Stockholm, Sweden
| | - Tore Dag Bøe
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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14
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McPherson P, Lloyd-Evans B, Dalton-Locke C, Killaspy H. A Systematic Review of the Characteristics and Efficacy of Recovery Training for Mental Health Staff: Implications for Supported Accommodation Services. Front Psychiatry 2021; 12:624081. [PMID: 34054593 PMCID: PMC8160251 DOI: 10.3389/fpsyt.2021.624081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Evidence suggests a link between recovery-oriented practise and service user outcomes in supported accommodation settings. Current clinical guidelines recommend recovery training for supported accommodation staff, however evidence relating to the effectiveness of this type of training is unclear. This review aimed to describe and compare the characteristics and efficacy of existing recovery training packages for mental health staff. The appropriateness and applicability of the interventions was considered in relation to UK supported accommodation services. Initial search processes returned 830 papers. After duplicate removal, inclusion and exclusion criteria were applied to 489 papers, leaving a final sample of seven papers. Data were reviewed using a narrative synthesis approach. The reviewed papers showed variation in the aims, frequency, and duration of the training interventions, although all included content consistent with the five-domains of the CHIME model. All interventions used direct, in-person teaching, and prioritised interactive, experiential learning, however a number were limited by the absence of feedback, the use of one-off, rather than repeated/follow-up sessions, and a reliance on classroom-based, rather than in-vivo, training. There was limited evidence to suggest a consistent effect of training on staff or service user outcomes, and there was no clear association between the delivery and design characteristics of the interventions and reported outcomes. In considering the development of recovery training for supported accommodation staff, little guidance can be taken from the reviewed literature. Any training package must be developed with consideration of the unique contextual and organisational characteristics of these services. The authors recommend viewing training as one component of a broader goal of service transformation.
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15
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Tjörnstrand C, Eklund M, Bejerholm U, Argentzell E, Brunt D. A day in the life of people with severe mental illness living in supported housing. BMC Psychiatry 2020; 20:508. [PMID: 33059664 PMCID: PMC7559196 DOI: 10.1186/s12888-020-02896-3] [Citation(s) in RCA: 4] [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: 08/16/2019] [Accepted: 09/24/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People with severe mental illness (SMI) living in supported housing (SH) struggle in everyday life and we currently lack a comprehensive body of knowledge concerning how the residents experience their day. This paper aimed to gain knowledge about how people with SMI describe a day in SH in Sweden, in particular the activities they most frequently engage in and how they experience what they do in or outside their home. Furthermore, it is important to gain knowledge of which activities motivate residents to leave the housing facility and to participate in the community. This new knowledge can help staff to encourage a recovery process among the residents. METHODS One hundred thirty-three people living in SH completed a time-use diary and a mixed-methods approach was applied, including calculations of what activity that was most frequently performed and a manifest content analysis addressing experiences of activity. RESULTS The residents had a low activity level and were often alone. Approximately one-half of the reported activities were performed in their own apartments, and generally unaccompanied. A quarter of the activities were performed in the common areas and a further quarter outside the SH. The most frequently performed activities were quiet and tranquil ones, e.g. listening to music and resting. Doing errands and group activities with staff and residents were the main activities that motivated leaving the facility. The participant experience of a day is presented in three categories: "Experiences of chosen and enforced togetherness and overcoming loneliness", "Environmental change and emotional balance can generate activity", and "Met and unmet needs for support, friendship and security". CONCLUSIONS The residents were generally satisfied with their quiet and tranquil lifestyle and appeared to demand little of life, which may relate to previous experiences of institutional life and can constitute a challenge for staff. The findings highlight experiences that can help to improve SH. Services need to support individually adjusted contextual stimuli and individualize the support to help residents find a good balance and motivate them to be active in and outside SH, which can support a recovery process.
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Affiliation(s)
- Carina Tjörnstrand
- Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University, Box 157, SE 221 00, Lund, Sweden.
| | - Mona Eklund
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University, Box 157, SE 221 00 Lund, Sweden
| | - Ulrika Bejerholm
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University, Box 157, SE 221 00 Lund, Sweden
| | - Elisabeth Argentzell
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University, Box 157, SE 221 00 Lund, Sweden
| | - David Brunt
- grid.8148.50000 0001 2174 3522Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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16
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Harrison M, Singh Roy A, Hultqvist J, Pan AW, McCartney D, McGuire N, Irvine Fitzpatrick L, Forsyth K. Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:977-988. [PMID: 32448927 PMCID: PMC7395041 DOI: 10.1007/s00127-020-01885-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. METHODS Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. RESULTS 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. CONCLUSION There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.
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Affiliation(s)
- Michele Harrison
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
| | - Anusua Singh Roy
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
| | - Jenny Hultqvist
- Mental Health, Activity and Participation (MAP), Department of Health Sciences, Lund University, Lund, Sweden
| | - Ay-Woan Pan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Deborah McCartney
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
- Present Address: Adult Learning Disability Service, Lynebank Hospital, Dunfermline, UK
| | - Nicola McGuire
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
- Present Address: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Irvine Fitzpatrick
- Mental Health and Wellbeing, City of Edinburgh Health and Social Care Partnership, Edinburgh, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
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17
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Housing and Support for non-homeless individuals with severe mental illness: randomised controlled trial vs. observational study - study protocol. BMC Psychiatry 2020; 20:319. [PMID: 32560681 PMCID: PMC7304176 DOI: 10.1186/s12888-020-02712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland. METHODS This is a prospective multi-centre, four-arm, non-inferiority cohort study investigating the effectiveness and efficiency of IHS and RCS/TAU for people with SMI. Effectiveness will be measured by a standardised measure of social inclusion as primary outcome as well as by measures of functioning and well-being. Efficiency will be analysed on the basis of service usage and costs associated with the different housing settings. Participants will be consecutively recruited and subsequently enrolled between April 2019 and December 2020 and assessed at baseline and after six, twelve and after 24 months. At one study site, 56 participants will be randomly assigned to one of the conditions; the other study site will be conducted as an observational study investigating 112 admitted participants. DISCUSSION While the UN Convention of the Rights of People with Disabilities aims to promote the opportunity to choose one's place of residence, the limited supply of alternative forms of housing does not guarantee genuine freedom of choice. Increased diversification and flexibility of housing support is essential. If IHS shows non-inferiority in terms of their effectiveness and efficiency, users should be allowed to choose their kind of housing support. TRIAL REGISTRATION ClinicalTrials.gov: NCT03815604, December 04, 2019.
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Affiliation(s)
- Christine Adamus
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Murtenstrasse 46, CH-3008, Bern, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Murtenstrasse 46, CH-3008, Bern, Switzerland
- Departement of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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18
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Killaspy H, Priebe S, McPherson P, Zenasni Z, Greenberg L, McCrone P, Dowling S, Harrison I, Krotofil J, Dalton-Locke C, McGranahan R, Arbuthnott M, Curtis S, Leavey G, Shepherd G, Eldridge S, King M. Predictors of moving on from mental health supported accommodation in England: national cohort study. Br J Psychiatry 2020; 216:331-337. [PMID: 31046864 DOI: 10.1192/bjp.2019.101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Around 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness. AIMS A 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation. METHOD We used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics. RESULTS Overall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92-21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01-7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice. CONCLUSIONS Most people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
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Affiliation(s)
- Helen Killaspy
- Professor of Rehabilitation Psychiatry, Division of Psychiatry, University College London, UK
| | - Stefan Priebe
- Professor of Social and Community Psychiatry, Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, UK
| | - Peter McPherson
- Research Associate, Division of Psychiatry, University College London, UK
| | - Zohra Zenasni
- Statistician, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Lauren Greenberg
- Statistician, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Paul McCrone
- Professor of Health Economics, King's Health Economics, King's College London, UK
| | - Sarah Dowling
- Project Manager, Division of Psychiatry, University College London, UK
| | - Isobel Harrison
- Research Associate, Division of Psychiatry, University College London, UK
| | - Joanna Krotofil
- Research Associate, Division of Psychiatry, University College London, UK
| | | | - Rose McGranahan
- Research Assistant, Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, UK
| | - Maurice Arbuthnott
- Service User Representative, North London Service-User Research Forum, Division of Psychiatry, University College London, UK
| | - Sarah Curtis
- Professor Emerita, Department of Geography, Durham University, UK
| | - Gerard Leavey
- Director, Bamford Centre for Mental Health and Wellbeing, University of Ulster, Northern Ireland
| | | | - Sandra Eldridge
- Professor of Biostatistics, Pragmatic Clinical Trials Unit, Queen Mary University London, Blizard Institute, Barts and The London School of Medicine and Dentistry, UK
| | - Michael King
- Professorial Research Associate, Division of Psychiatry, University College London, UK
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19
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Apostolopoulou A, Stylianidis S, Issari P, Chondros P, Alexiadou A, Belekou P, Giannou C, Karali EK, Foi V, Tzaferou F. Experiences of Recovery in EPAPSY's Community Residential Facilities and the Five CHIME Concepts: A Qualitative Inquiry. Front Psychiatry 2020; 11:24. [PMID: 32116841 PMCID: PMC7031485 DOI: 10.3389/fpsyt.2020.00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
In the context of the reform of psychiatric services in Greece, the debate about the concept of recovery is still growing. Recovery is defined as a path through which individuals facing mental health challenges are enabled to regain and further develop significant relationships with family, friends, the community, and themselves and at the same time to cope with the detrimental effects of stigma through empowerment. The present qualitative study aims to explore the experiences of people living in EPAPSY's (Association for Regional Development and Mental Health) community residential facilities focusing mainly upon the key concepts of the CHIME (connectivity, hope, identity, meaning, and empowerment) conceptual framework of recovery. To this end, semi-structured interviews were conducted with seven participants living and receiving mental health care in a residential facility of EPAPSY. The participants' accounts were analyzed using thematic analysis in a deductive and inductive manner. The research findings highlighted, among others, the challenges the participants faced during their early years in family and school, the experience of the revolving door effect, and the perceived turn their life took when they were transferred to a community residential facility, thus opening a new chapter in their lives. Of the five CHIME concepts, all are present in the participants' accounts, with emphasis given to a meaningful present, a need to feel "normal" again, and a positive outlook for the future, both for themselves and their relationships, despite the persistence of certain difficulties.
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Affiliation(s)
| | - Stelios Stylianidis
- Department of Psychology, Panteion University for Social and Political Sciences, Athens, Greece
| | - Philia Issari
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Chondros
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Amalia Alexiadou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Pepy Belekou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Charalambos Giannou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Eleni K. Karali
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Vana Foi
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
| | - Fotini Tzaferou
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece
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20
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Brunt D, Schröder A, Lundqvist LO, Rask M. Residents' Perceptions of Quality in Supported Housing for People with Psychiatric Disabilities. Issues Ment Health Nurs 2019; 40:697-705. [PMID: 31099719 DOI: 10.1080/01612840.2019.1585496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The residents' perspective of the quality of housing support for people with psychiatric disabilities living in congregate supported housing has been studied and a comparison has been made with the findings from those from a previous study in ordinary housing with outreach support. One-hundred and seventy-eight residents from 27 supported housing facilities in eight Swedish municipalities completed the Quality of Psychiatric Care-Housing (QPC-H) instrument. The highest quality ratings were found for: Secluded Environment, Encounter and Support, while Participation, Housing Specific and Secure Environment were rated at lower levels. Despite relatively high ratings, a majority of items did not attain the 80% cutoff point deemed as defining satisfactory quality of service. The residents in ordinary housing with outreach support rated higher levels for the majority of the QPC-H dimensions in comparison with those in supported housing. A conclusion is that the quality of care in supported housing facilities has a number of deficiencies that need to be addressed. Supported housing is generally rated as having a lower quality of care than in ordinary housing with outreach support. Suggestions for the content of staff training are made based on the results.
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Affiliation(s)
- David Brunt
- a School of Health and Caring Sciences , Linnaeus University , Växjö , Sweden
| | - Agneta Schröder
- b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.,c Department of Nursing, Faculty of Health, Care and Nursing , Norwegian University of Science and Technology (NTNU) , Gjövik , Norway
| | - Lars-Olov Lundqvist
- b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Mikael Rask
- a School of Health and Caring Sciences , Linnaeus University , Växjö , Sweden
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21
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Kerman N, Gran-Ruaz S, Lawrence M, Sylvestre J. Perceptions of Service Use Among Currently and Formerly Homeless Adults with Mental Health Problems. Community Ment Health J 2019; 55:777-783. [PMID: 30798452 DOI: 10.1007/s10597-019-00382-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
This qualitative study used in-depth interviews to examine the service experiences of 52 currently and formerly homeless people with mental health problems. Thematic analysis identified five themes associated with positive and negative service experiences: (1) accessibility of services, (2) humanity in approach to care, (3) perceptions and relationships with other service users, (4) physical space and environment, and (5) outcomes of service use. Overall, minimal differences were found between currently and formerly homeless people with mental health problems, suggesting that both groups have the same wants and needs related to service use, including to be treated fairly and without judgment, receive needed support and assistance, and feel good following their service experience. However, both groups also described encountering barriers to accessing programs and navigating service systems; using services where they felt judged, unsafe, or uncared for; and having unmet needs following service use.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Sophia Gran-Ruaz
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | | | - John Sylvestre
- School of Psychology, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
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22
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Friesinger JG, Topor A, Bøe TD, Larsen IB. Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review. Health Place 2019; 57:44-53. [PMID: 30959400 DOI: 10.1016/j.healthplace.2019.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022]
Abstract
Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.
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Affiliation(s)
| | - Alain Topor
- University of Agder, Department of Psychosocial Health, Grimstad, Norway; Stockholm University, Department of Social Work, Stockholm, Sweden
| | - Tore Dag Bøe
- University of Agder, Department of Psychosocial Health, Grimstad, Norway
| | - Inger Beate Larsen
- University of Agder, Department of Psychosocial Health, Grimstad, Norway
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23
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Piat M, Seida K, Padgett D. Choice and personal recovery for people with serious mental illness living in supported housing. J Ment Health 2019; 29:306-313. [DOI: 10.1080/09638237.2019.1581338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montréal, Canada
| | | | - Deborah Padgett
- Silver School of Social Work, New York University, New York, NY, USA
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24
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Fossey E, Harvey C, McDermott F. Housing and Support Narratives of People Experiencing Mental Health Issues: Making My Place, My Home. Front Psychiatry 2019; 10:939. [PMID: 31998158 PMCID: PMC6966198 DOI: 10.3389/fpsyt.2019.00939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/27/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Choice, control, privacy, and security are widely reported housing preferences of mental health consumers, are associated with improved well-being and greater housing satisfaction, and are important for recovery. This paper describes housing and neighborhood experiences from a larger qualitative study that sought to learn with people experiencing mental health issues about their everyday lives in an Australian urban community. Methods: A participatory approach to health research informed this study. A participatory reference group, including four people with consumer perspective knowledge and experience of mental health issues and four mental health practitioners with service provider and researcher perspectives, worked together to design and implement this study over a 4-year period. Thirty-nine participants were recruited, including 18 women and 21 men living in metropolitan Melbourne and receiving community mental health care for ongoing mental health issues related mainly to either psychotic or affective disorders. Participants each took part in one to three interviews or a focus group. The data were transcribed and analyzed using narrative and thematic analytic strategies, underpinned by reflective discussions with the participatory reference group. Findings: Participants' experiences of their housing and neighborhoods emphasized qualities that either contributed to or challenged their sense of being "at home." Identifying with a place as home was transformative, especially when supported by friendly neighborhood interactions, safety, and accessibility of local amenities. Unsatisfactory housing situations and limited income worked against participants' efforts to regain a sense of well-being and improve their situations. When being home was challenging, strategies used to counteract this included getting a pet and getting out as a means of resisting isolation at home. Differing views and ways of using the available support workers were described, suggesting tensions between seeking to be self-sufficient and valuing support. Conclusions: Social housing locations and housing-related support should explicitly attend to safety and security concerns. Collaborative care planning and outreach support should attend to supports for navigating issues with neighbors, housing, harnessing natural supports, and opportunities for being in others' company, as well as recognizing the importance of pets in people's lives. Understanding the strategies that mental health consumers find helpful in creating a sense of being at home, and the role of "place" in recovery merit further consideration in research and practice.
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Affiliation(s)
- Ellie Fossey
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia.,Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Melbourne, VIC, Australia
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25
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Soares LDML, Silva PRFD. Serviços Residenciais Terapêuticos na cidade do Rio de Janeiro: uma análise da estrutura e do processo de cuidado. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do artigo foi analisar a estrutura e o processo de cuidado nos Serviços Residenciais Terapêuticos existentes no município do Rio de Janeiro. Trata-se de um estudo transversal que se concentrou na coleta de informações primárias por meio de instrumento estruturado. A pesquisa foi realizada em todos os dispositivos em funcionamento no mês de dezembro de 2016. No Rio de Janeiro, as Residências Terapêuticas recebem essencialmente pacientes egressos de internações psiquiátricas de longa permanência (94,3%), com grande oferta de vagas em dispositivos com presença de equipe nas 24 horas do dia (63,8%). Foi constatado que parte significativa dos moradores apresentava baixa frequência nas atividades assistenciais dos Centros de Atenção Psicossocial (48,7%). O cuidado interno nos dispositivos residenciais aponta para uma modelagem com forte entrelaçamento entre a moradia e as ações de reabilitação psicossocial. A baixa rotatividade de usuários mostra uma tendência para constituição de serviços com cuidado de longo prazo, o que deve ser levado em conta na manutenção e na expansão do programa no intuito de planejar serviços efetivos. Os resultados apontam que as bolsas de apoio à desinstitucionalização e, principalmente, a renda contínua aferida mediante o Benefício de Prestação Continuada são vitais para a sustentabilidade do programa.
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26
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Boardman J. Mental Health and Social Care and Social Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112328. [PMID: 30360463 PMCID: PMC6267323 DOI: 10.3390/ijerph15112328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 06/08/2023]
Abstract
In common parlance, the term 'social' is used in many senses ranging from the way society is organised to the rank or status someone has in society; to activities that involve meeting with other people; to the experience, behaviour and interaction of persons forming groups; and to promoting companionship and communal activities. [...].
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Affiliation(s)
- Jed Boardman
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London SE5 8AF, UK.
- Centre for Mental Health, Unit 2D21, Technopark, South Bank University, 90 London Road, London SE1 6LN, UK.
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