Supported accommodation for people with severe mental illness: a review

The development of supported mental health accommodation and community psychiatric nursing in Oxfordshire

Overcrowding in British mental hospitals was a major service and political concern when the NHS was introduced in 1948. From 1959, a number of projects were initiated locally in Oxfordshire, based from Littlemore Hospital Oxford, to provide alternative accommodation, primarily for long-stay residents. Two NHS hostels were opened and a network of group homes was developed from 1963. These were administered through the hospital League of Friends and supported by the community psychiatric nursing service led by Helmut Leopoldt. From 1977 a separate local charity, Oxfordshire Mind, also provided supported housing for younger patients. These developments can be seen as an early local case study of the provision of non-hospital (supported) accommodation and other forms of support for people with long-term mental health problems.

Participation in sport and physical activity in adults with intellectual disabilities

BACKGROUND

People with intellectual disability face a number of barriers to participation in physical activity. This paper aimed to determine rates of sport and physical activity participation in an Australian sample of adults with intellectual disability, compared with rates of participation in the general Australian population. A secondary aim was to investigate factors that may contribute to participation of adults with intellectual disability.

METHOD

Participants were part of the Australian Child to Adult Development (ACAD) study, consisting of a community sample with intellectual disability (n = 305), groups of adults with autism (n = 94), Down syndrome (n = 64), fragile X syndrome (n = 52), Williams syndrome (n = 45), and Prader-Willi syndrome (n = 30). Participation in sport/physical activity was reported over the past 3 months. Rates of participation were reported for adults with intellectual disability and compared with rates in a general Australian population sample. The relationship between participation in physical activity and age, degree of intellectual disability, physical mobility, living situation, socio-economic disadvantage, and behaviour and emotional problems were also conducted.

RESULTS

Participants in the ACAD community sample with intellectual disability participated in sport/physical activity at lower rates than the general Australian population (42% compared with 71%). Having no physical mobility impairment was significantly associated with higher rates of participation. Those with Down syndrome participated in sport/physical activity at higher rates than the community sample with intellectual disability, while no difference in sport/physical activity participation was observed in the groups with autism or other syndromes.

CONCLUSION

Australian adults with intellectual disability participate in sport and physical activity at lower rates than the general population. Having a physical mobility impairment was associated with lower rates of participation. However, people living in supported accommodation were more likely to participate than those in other living situations. Having Down syndrome was associated with a higher participation rate than the community sample.

[Current trends in the development of psychiatric care system]

In this article, the authors summarize current trends in the development of domestic and foreign mental health services, results of the reforms of national psychiatric services, and the state of inpatient and community-based psychiatric care systems. Actual problems and prospects of development of system of psychiatric help are discussed.

Disordered lives: Life circumstances and clinical characteristics of very frequent users of emergency departments for primary mental health complaints

This study explored the life circumstances and clinical characteristics of very frequent users of emergency departments (EDs) presenting with a primary mental health complaint. Patients with 10 or more EDs visits in 2012 with a primary psychiatric diagnosis in a Canadian regional health authority were identified from electronic administrative files. The hospital charts for these patients were thoroughly reviewed for a three-year period, from 2011 to 2013. A retrospective thematic analysis was undertaken. Very frequent users of EDs were generally young to early middle aged, unemployed, living in transient accommodations, having substance abuse diagnoses, and self-referred to EDs for a variety of psychiatric and health symptoms and/or unmet needs. Four themes were identified: 1) substance abuse and associated health and social problems; 2) common mental disorders, which may include suicidality; 3) social and personal stressors with additional common mental disorders and somatic complaints; 4) cognitive impairment with concurrent psychiatric disorders. Traditional mental health services are ineffective in dealing with patients with complex psychiatric and social problems/needs. Efforts should focus on early detection, intervention, reducing mental and behavior problems, and developing appropriate case management and treatment options. Personalized care models are needed to meet their diverse needs.

Prevalence of housing needs among inpatients: a 1 year audit of housing needs in the acute mental health unit in Tallaght Hospital

OBJECTIVE

There is a dearth of information relating to the prevalence of housing needs among psychiatric in-patients in Ireland. Most of the information we have to date emerged as a result of attempts to plan for the closure of old psychiatric hospitals and inappropriate community residences. This study sought to identify the prevalence of housing needs among in-patients in the acute psychiatric unit in Tallaght Hospital.

METHODS

Each week, over a 12-month period, nursing managers and/or key nurses who knew the patients well were asked for numerical data. Information was collected on the numbers of in-patients with accommodation needs, number of delayed discharges due to accommodation needs and number of discharges to homeless accommodation in the previous week.

RESULTS

On average, 38% of in-patients had accommodation related needs at any one time. Most (98%) of delayed discharges had accommodation related needs. Delayed discharge in-patients with accommodation needs accounted for 28% of all inpatients and for 72% of all inpatients with accommodation related needs.

CONCLUSIONS

Accommodation need among psychiatric in-patients is underreported. Housing need data should be routinely collected and effective interagency strategies developed to address housing needs.

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial

BACKGROUND

We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention.

METHOD

We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy.

RESULTS

The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills).

CONCLUSION

This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).

Individual care packages for people with severe mental illness: a description of their implementation in an English County

BACKGROUND

This paper includes a brief review of the historical and policy background to a new form of supported accommodation, the Individual Care Package (ICP). This is a co-ordinated, individualised and flexible method to support people with complex mental health problems in the community.

METHOD

The study aimed to describe the implementation of this new form of care in Gloucestershire, England, over a 5-year period. We aimed to audit the quality of care in the packages against six care standards, derived by a project steering group. Staff working in community mental health services and staff providing ICPs were asked to report their levels of satisfaction with care provision.

RESULTS

A total of 35 ICPs were developed, mostly relating to service users with severe mental illness. Only 60% of the community mental health team key workers were aware of the expected level of care. In many cases, service users were accessing support from day services or family alongside the ICP. Four service users were admitted, and four moved accommodation after going into ICPs. Overall, levels of care provided within ICPs tended to remain static. Trust key workers were mostly satisfied with the support provided in ICPs, but a range of concerns were expressed. ICP staff reported mostly positive views about the support that they received from statutory services, but also reported some concerns.

CONCLUSIONS

ICPs appeared to be successful in enabling a number of service users with complex difficulties to obtain and maintain tenancies in the community. There were some concerns about the quality of monitoring of the ICPs and some uncertainty about whether ICP staff would have the skills, support and training to promote recovery and increasing independence of service users. There was little evidence of service users moving on or reduction in care over time. There is a need for good inter-agency working for the successful deployment of this new form of service. There is also a need for more research, comparing ICPs with other forms of supported accommodation and considering the service user experience through qualitative research.

Quality of life and unmet need in people with psychosis in the London Borough of Haringey, UK

OBJECTIVES

Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers.

DESIGN

Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing.

SETTING

London Borough of Haringey.

OUTCOME MEASURES

110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information.

RESULTS

People in "low-support" and "high-support" housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably.

CONCLUSIONS

Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of "recovery" is to advance.

The Vron - An Early Intervention In-patient Recovery Unit

BACKGROUND AND AIMS

This paper describes the context in which the Vron, a six-bedded 24-hour nursed care unit, has developed its role from a fast track rehabilitation unit, to work explicitly within an early intervention service. The study aimed to evaluate the work of the Vron by examining the change in CANSAS, HoNOS and EM scores between admission to and discharge from the unit.

RESULTS

Approximately half of the admissions to Vron were from acute psychiatric wards. Most patients were discharged to their own tenancy or supported accommodation. There was a significant reduction in mean HoNOS score and increase in mean EM score during admission. Mean staff and patient-rated unmet needs reduced in the course of admission. In the course of admission, approximately half of the patients developed occupational roles.

DISCUSSION AND CONCLUSIONS

The findings of this service evaluation must be interpreted with caution in view of the methodological limitations, in particular the lack of a comparator service intervention. However, it is suggested that units of this type may have a useful role in the rehabilitation of patients with complex severe mental illness, particularly if deployed at an early stage in an individual's illness, to prevent development of disability. The Vron focuses on a number of specific clinical and social areas which align with typical strategies in early intervention.