Landlord-supervised cooperative apartments: a new modality for community-based treatment

A social ecological approach to investigating relationships between housing and adaptive functioning for persons with serious mental illness

This paper seeks to advance mental health-housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health-housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health-housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework-physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing-allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings-survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.

Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.

Half-way services in the rehabilitation of chronic mental patients. A residential programme

The importance of adequate community facilities in the rehabilitation of chronic mental patients is stressed. In view of the common reluctance of relatives to accept this type of patient back home again, a residential programme was designed to obviate this problem. The rehabilitation unit described, achieved reintegration into the community of 36.1% of the patients through the use of hotels and sheltered accommodation. In all, 58.4% of the patients were discharged. Finally, mention is made of the advantage of the system, especially its economy, availability, and helpful collaboration of landladies.

The use of a mid-Manhattan hotel as a support system

The mass media have focused recently on the failure of psychiatric institutions to provide adequate follow-up for its patients released into the inner city. Many expatients deteriorate and become part of the "revolving door": single-room occupancy--city hospitals--state hospital. This paper attempts to demonstrate the feasibility of utilizing existing community resources (for example, a large midtown Manhattan hotel and local service agencies) to cope with this problem. A description of the multiagency organized hotel programs as well as objective and subjective data is provided in order to substantiate our contention that this approach offers a viable alternative to long-term hospitalization.