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Dehn LB, Beblo T, Richter D, Wienberg G, Kremer G, Steinhart I, Driessen M. Effectiveness of supported housing versus residential care in severe mental illness: a multicenter, quasi-experimental study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:927-937. [PMID: 35041013 PMCID: PMC9042980 DOI: 10.1007/s00127-021-02214-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Up to now there are only few studies and no RCT comparing efficacy or effectiveness of supported housing (SH) versus residential care (RC) in severe mental illness (SMI) without homelessness. Here we present an observational follow-up study in SMI subjects, who entered SH or RC, to compare clinical and functional outcomes 2 years later. METHODS In this prospective study in more than 30 locations throughout a German federal state, we included SMI subjects, who entered SH (n = 153) or RC (n = 104). About one quarter suffered from each substance use, psychotic, affective, or other disorders. To avoid sampling bias, we used the propensity score matching method to establish a quasi-experimental design. Outcome measures were social functioning (SFS), the number of psychiatric hospitalisations, psychopathology (SCL-9-K), and quality of life (MANSA). Apart from descriptive methods we analysed primarily using repeated-measures ANOVAS. RESULTS Our analyses revealed significant effects of time for all outcomes in both study groups. However, there were not any group differences of outcome measures, i.e., not any significant effects of group or interactional effects of group x time. Moreover, these results hold true for intent-to-treat and per-protocol sample analyses. CONCLUSION The results show, that SH and RC for non-homeless people with SMI achieve the same clinical and psychosocial outcomes across a 2-year period. Taking into account the users' preferences, the present findings should give reason to ensure the availability of affordable housing and to support the expansion of supported housing approaches.
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Affiliation(s)
- Lorenz B Dehn
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL, Remterweg 69-71, 33617, Bielefeld, Germany.
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL, Remterweg 69-71, 33617, Bielefeld, Germany
| | - Dirk Richter
- Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Georg Kremer
- Bethel.regional, Stiftung Bethel, Bielefeld, Germany
| | - Ingmar Steinhart
- von Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e. V., University of Greifswald, Greifswald, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Evangelisches Klinikum Bethel, University Hospital OWL, Remterweg 69-71, 33617, Bielefeld, Germany
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Psychological Health Status of Psychiatric Patients Living in Treatment Communities before and during the COVID-19 Lockdown: A Brief Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073567. [PMID: 33808178 PMCID: PMC8037022 DOI: 10.3390/ijerph18073567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/14/2022]
Abstract
Many studies investigated the psychological impact of lockdown measures on the general population, while few studies focused on the psychiatric population. This study aimed to investigate the role of therapeutic communities in the management and containment of symptoms of patients with psychosis living in psychiatric residential facilities. Data were collected at two different points: November 2019 (Coronavirus disease 19 had not yet spread) and April 2020 (during the lockdown in Italy). Twenty-two study participants were recruited from three residential accredited psychiatric facilities. During lockdown, the patients showed a small increase in symptomatology in terms of emotional isolation. In addition, it was been observed significant differences in certain functional areas of the behavior, measured as lower inclination towards violent behaviors during lockdown, and higher scores in substance abuse and medical impairment. The lockdown condition could represent a form of containment; daily routines, along with adequate social support, are important aspects of the stability and the level of behavioral functioning of psychiatric patients. Social support and continuity of care offered by psychiatric communities can be an effective safeguard against the psychological impact of the COVID-19 epidemic.
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Dalton-Locke C, Marston L, McPherson P, Killaspy H. The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis. Front Psychiatry 2020; 11:607933. [PMID: 33519552 PMCID: PMC7838487 DOI: 10.3389/fpsyt.2020.607933] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction: Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services. Methods: We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out. Results: We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services (n = 34); services for homeless people with severe mental health problems (n = 13); deinstitutionalization programmes (n = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes. Conclusions: Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required. Review registration: This review was prospectively registered on PROSPERO (ID: CRD42019133579).
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Affiliation(s)
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington National Health Service Foundation Trust, London, United Kingdom
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de Mooij LD, Kikkert M, Theunissen J, Beekman ATF, de Haan L, Duurkoop PWRA, Van HL, Dekker JJM. Dying Too Soon: Excess Mortality in Severe Mental Illness. Front Psychiatry 2019; 10:855. [PMID: 31920734 PMCID: PMC6918821 DOI: 10.3389/fpsyt.2019.00855] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Aims: We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality. Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time. Results: Almost 11% of the SMI patients had died at the end of the study period. All-cause SMRs were 4.51 (95% CI 3.07-5.95) for all SMI patients (4.89, 95% CI 2.97-6.80 for men, and 3.94, 95% CI 1.78-6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02-1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21-2.52). Conclusions: The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.
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Affiliation(s)
| | - Martijn Kikkert
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Jan Theunissen
- Department of Research, GGZ inGeest Mental Health Institute, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Research, GGZ inGeest Mental Health Institute, Amsterdam, Netherlands.,Department of Psychiatry, VU-University Medical Centre, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands.,Department of Psychiatry, Academic Medical Center, Amsterdam, Netherlands
| | - Pim W R A Duurkoop
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Henricus L Van
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands.,Department of Clinical Psychology, VU-University Medical Centre, Amsterdam, Netherlands
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McPherson P, Krotofil J, Killaspy H. Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes. BMC Psychiatry 2018; 18:128. [PMID: 29764420 PMCID: PMC5952646 DOI: 10.1186/s12888-018-1725-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 05/04/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services. METHODS Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: 'Homeless', 'Deinstitutionalisation' and 'General Severe Mental Illness (SMI)'. RESULTS Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research. CONCLUSIONS A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.
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Affiliation(s)
- Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Joanna Krotofil
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Helen Killaspy
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Koenders JF, de Mooij LD, Dekker JM, Kikkert M. Social inclusion and relationship satisfaction of patients with a severe mental illness. Int J Soc Psychiatry 2017; 63:773-781. [PMID: 29067839 DOI: 10.1177/0020764017737572] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research suggests that patients with a severe mental illness (SMI) are among the most social excluded in society. However, comparisons of social network composition and relationship satisfaction between SMI patients and a control group are rare. AIMS Our aim was to compare differences in size, satisfaction and composition of the social network between patients with SMI and a control group. Potential sociodemographic and clinical risk factors in relation to social network size in SMI patients were explored. METHODS The sample consisted of a control group ( N = 949) and SMI patients ( N = 211) who were under treatment in Dutch mental health care institutions. In these groups, network size, relationship satisfaction, sociodemographic and clinical (patients only) characteristics were assessed. RESULTS Social network size was 2.5 times lower in SMI patients, which was also reflected in a lower relationship satisfaction. The composition of the social network of SMI patients differs from that of controls: patients' network seems to consist of a smaller part of friends. Different risk factors were associated with the impoverishment of the social network of family, friends and acquaintances of patients with SMI. CONCLUSION SMI patients have very small networks compared to controls. This may be a problem, given the ongoing emphasis on outpatient treatment of SMI patients and self-dependence. This outcome advocates for more attention to social isolation of SMI patients and involvement of family in the treatment and aftercare of SMI patients.
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Affiliation(s)
- Jitske F Koenders
- 1 Departement of Research, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Liselotte D de Mooij
- 1 Departement of Research, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Jack M Dekker
- 1 Departement of Research, Arkin Mental Health Institute, Amsterdam, The Netherlands.,2 Departement of Clinical Psychology, Free University of Amsterdam, Amsterdam, The Netherlands.,3 Depression Research Club, Amsterdam, The Netherlands
| | - Martijn Kikkert
- 1 Departement of Research, Arkin Mental Health Institute, Amsterdam, The Netherlands
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