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Ang MS, Rekhi G, Lee J. Associations of living arrangements with symptoms and functioning in schizophrenia. BMC Psychiatry 2021; 21:497. [PMID: 34635064 PMCID: PMC8507381 DOI: 10.1186/s12888-021-03488-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Living arrangements and accommodation are closely related, but no study had concurrently investigated their associations with outcomes in schizophrenia. This study seeks to describe and compare socio-demographic, clinical and functioning profiles of people with schizophrenia in different living arrangements and accommodation, and to examine the associations of living arrangements and accommodation with symptomatic remission and functioning. METHODS Community dwelling outpatients with schizophrenia (n = 276) were inquired on living arrangements, accommodation, socio-demographics and assessed on the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). Socio-demographics, symptoms and functioning of outpatients in different living arrangements and accommodation were compared. Symptomatic remission was investigated using logistic regression with living arrangements, socio-demographics and clinical variables as independent variables. Functioning was investigated using multiple regression with the same set of independent variables and the addition of PANSS factors. The same analyses were conducted with accommodation as independent variable. RESULTS 185 (67.03%) participants lived with family and 195 (70.65%) participants lived in owned accommodation. People living with their spouses had significantly higher SOFAS, lower PANSS Total and PANSS Positive than people living with family, independently, or in rehabilitation centres. They also had lower PANSS Negative than people living with family and a higher likelihood to have achieved symptomatic remission. Types of accommodation was not associated with symptoms, symptomatic remission, and functioning. CONCLUSION Living arrangements, but not types of accommodation, were associated with symptoms and functioning in schizophrenia. Family education and support is important to help maintain a conducive environment for people with schizophrenia. People living independently may need more support.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Gurpreet Rekhi
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore ,grid.414752.10000 0004 0469 9592North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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2
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Mötteli S, Adamus C, Deb T, Fröbel R, Siemerkus J, Richter D, Jäger M. Independent Supported Housing for Non-homeless People With Serious Mental Illness: A Pragmatic Randomized Controlled Trial. Front Psychiatry 2021; 12:798275. [PMID: 35126208 PMCID: PMC8814620 DOI: 10.3389/fpsyt.2021.798275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Independent supported housing (ISH)-services to support independent housing are recommended by current guidelines. However, there is little evidence of ISH models for non-homeless people with severe mental illness (SMI). The aim of this study was to examine the effectiveness of ISH by comparing the clinical outcomes of a newly implemented ISH service with regular housing and support services. METHODS A total of 58 adults with a broad spectrum of mental disorders experiencing housing problems were randomly assigned to either the intervention group (IG) with the possibility to use the ISH service in Zurich providing targeted, individual and flexible support for housing problems or to the control group (CG) with regular housing and support services currently available (trial registration at ClinicalTrials.gov: NCT03815604). RESULTS After 12 months, almost all participants of the IG were able to live independently and need for inpatient treatment could be significantly reduced. Service utilization varied between 2 and 79 h. In the CG, 70% of the participants wanted to join a waiting list for the ISH service. The results indicated that IHS was comparable to regular housing and support services in terms of social inclusion and other social and clinical outcomes such as quality of life, capabilities, needs, mental state and functioning (p's > 0.05). The costs of service utilization were on average 115 Swiss Francs (about 124 USD) per participant per month. CONCLUSIONS ISH is an effective service in housing rehabilitation in terms of social and clinical outcomes and costs. ISH is strongly preferred by service users. In line with the UN Convention on the Rights of Persons with Disabilities, access to ISH services for non-homeless people with SMI should be improved. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT03815604, December 04, 2019.
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Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Christine Adamus
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tim Deb
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Rahel Fröbel
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jakob Siemerkus
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Dirk Richter
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Center for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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3
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Ferreiro IC, Abad JMH, Cuadra MAR. Loneliness in Homeless Participants of a Housing First Program: Outcomes of a Randomized Controlled Trial. J Psychosoc Nurs Ment Health Serv 2020; 59:44-51. [PMID: 33301047 DOI: 10.3928/02793695-20201203-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/07/2020] [Indexed: 11/20/2022]
Abstract
People who are homeless are likely to experience loneliness. Housing First (HF) is a program aimed at providing home placement to homeless people who also have mental health and/or substance use-related problems. The current study was performed to assess feelings of loneliness among participants of a HF program. A randomized controlled trial was performed comparing participants in two groups, HF (n = 46) and treatment as usual (n = 41). No significant differences regarding loneliness between groups were noted at baseline (p = 0.841), 8-month follow up (p = 0.509), or 21-month follow up (p = 0.833); however, participants with severe mental illness reported higher feelings of loneliness at the 8-month assessment than at baseline. This increase was higher in HF participants. These findings are partially consistent with previous research and are of relevance for providers, policy makers, and teams working with HF programs. Findings indicate the need to address feelings of loneliness in this population. Further research is needed to ascertain the effectiveness of HF programs on loneliness. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 44-51.].
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4
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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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5
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Killaspy H, Priebe S, King M, Eldridge S, McCrone P, Shepherd G, Arbuthnott M, Leavey G, Curtis S, McPherson P, Dowling S. Supported accommodation for people with mental health problems: the QuEST research programme with feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Across England, around 60,000 people live in mental health supported accommodation: residential care, supported housing and floating outreach. Residential care and supported housing provide on-site support (residential care provides the highest level), whereas floating outreach staff visit people living in their own tenancies. Despite their abundance, little is known about the quality and outcomes of these services.
Objectives
The aim was to assess the quality, costs and effectiveness of mental health supported accommodation services in England. The objectives were (1) to adapt the Quality Indicator for Rehabilitative Care (QuIRC) and the Client Assessment of Treatment scale for use in mental health supported accommodation services; (2) to assess the quality and costs of these services in England and the proportion of people who ‘move on’ to less supported accommodation without placement breakdown (e.g. to move from residential care to supported housing or supported housing to floating outreach, or, for those receiving floating outreach, to manage with fewer hours of support); (3) to identify service and service user factors (including costs) associated with greater quality of life, autonomy and successful move-on; and (4) to carry out a feasibility trial to assess the required sample size and appropriate outcomes for a randomised evaluation of two existing models of supported accommodation.
Design
Objective 1 – focus groups with staff (n = 12) and service users (n = 16); psychometric testing in 52 services, repeated in 87 services (adapted QuIRC) and with 618 service users (adapted Client Assessment of Treatment scale). Objectives 2 and 3 – national survey and prospective cohort study involving 87 services (residential care, n = 22; supported housing, n = 35; floating outreach, n = 30) and 619 service users followed over 30 months; qualitative interviews with 30 staff and 30 service users. Objective 4 – individually randomised, parallel-group feasibility trial in three centres.
Setting
English mental health supported accommodation services.
Participants
Staff and users of mental health supported accomodation services.
Interventions
Feasibility trial involved two existing models of supported accommodation: supported housing and floating outreach.
Main outcome measures
Cohort study – proportion of participants who successfully moved to less supported accommodation at 30 months’ follow-up without placement breakdown. Feasibility trial – participant recruitment and withdrawal rates.
Results
The adapted QuIRC [QuIRC: Supported Accomodation (QuIRC-SA)] had excellent inter-rater reliability, and exploratory factor analysis confirmed its structural validity (all items loaded onto the relevant domain at the > ± 0.3 level). The adapted Client Assessment of Treatment for Supported Accommodation had good internal consistency (Cronbach’s alpha 0.89) and convergent validity (r
s = 0.369; p < 0.001). Supported housing services scored higher than residential care and floating outreach on six out of seven QuIRC-SA quality domains. Service users had a high prevalence of severe self-neglect (57%) and vulnerability to exploitation (37%). Those in supported housing (25%) and floating outreach (20%) experienced more crime than those in residential care (4%) but had greater autonomy. Residential care was the most expensive service (mean cost per resident per week was £581 for residential care, £261 for supported housing and £66 for floating outreach) but supported users with the greatest needs. After adjusting for clinical differences, quality of life was similar for users of supported housing and residential care (mean difference –0.138, 95% confidence interval –0.402 to 0.126; p = 0.306), whereas autonomy was greater for supported housing users (mean difference 0.145, 95% confidence interval 0.010 to 0.279; p = 0.035). Qualitative interviews showed that staff and service users shared an understanding of service goals and what constituted effective support. After adjusting for clinical differences, those in floating outreach were more likely to move on successfully at 30 months’ follow-up than those in residential care [odds ratio (OR) 7.96; p < 0.001] and supported housing (OR 2.74; p < 0.001), and this was more likely for users of supported housing than residential care (OR 2.90; p = 0.04). Successful move-on was positively associated with scores on two QuIRC-SA domains: the degree to which the service promoted ‘human rights’ (e.g. facilitating access to advocacy) and ‘recovery-based practice’ (e.g. holding therapeutic optimism and providing collaborative, individualised care planning). Service use costs for those who moved on were significantly lower than for those who did not. Recruitment in the feasibility trial was difficult: 1432 people were screened but only eight were randomised. Barriers included concerns about accommodation being decided at random and a perceived lack of equipoise among clinicians who felt that individuals needed to ‘step down’ from supported housing to floating outreach services.
Conclusions
We did not find clear evidence on the most effective model(s) of mental health supported accommodation. Indeed, our feasibility study suggests that trials comparing effectiveness cannot be conducted in this country. A range of options are required to provide appropriate support to individuals with differing needs.
Future work
Future research in this field requires alternatives to trials. Service planners should be guided by the mental health needs of the local population and the pros and cons of the different services that our study identified, rather than purely financial drivers.
Trial registration
Current Controlled Trials ISRCTN19689576.
Funding
This programme was funded by the National Institute for Heath Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information. The fundholders are Camden and Islington NHS Foundation Trust and the research is a collaboration between University College London, Queen Mary University of London, King’s College London, the University of Ulster and Durham University.
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Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, UK
- East London NHS Foundation Trust, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul McCrone
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Geoff Shepherd
- Implementing Recovery Through Organisational Change (ImROC), c/o Learning and Development, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Maurice Arbuthnott
- North London Service User Research Forum, Division of Psychiatry, University College London, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, University of Ulster, Londonderry, UK
| | - Sarah Curtis
- Institute of Hazard, Risk and Resilience, Durham University, Durham, UK
| | - Peter McPherson
- Division of Psychiatry, University College London, London, UK
| | - Sarah Dowling
- Division of Psychiatry, University College London, London, UK
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6
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Killaspy H, Priebe S, McPherson P, Zenasni Z, McCrone P, Dowling S, Harrison I, Krotofil J, Dalton-Locke C, McGranahan R, Arbuthnott M, Curtis S, Leavey G, MacPherson R, Eldridge S, King M. Feasibility Randomised Trial Comparing Two Forms of Mental Health Supported Accommodation (Supported Housing and Floating Outreach); a Component of the QuEST (Quality and Effectiveness of Supported Tenancies) Study. Front Psychiatry 2019; 10:258. [PMID: 31065244 PMCID: PMC6489479 DOI: 10.3389/fpsyt.2019.00258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Mental health supported accommodation services are implemented across England, usually organised into a 'step-down' care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. There have been no trials comparing the effectiveness of different types of supported accommodation, but two widely used models (supported housing and floating outreach) have been found to provide similar support. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models. Methods: Individually randomised, parallel group feasibility trial in three regions of England (North London, East London, and Cheltenham and Gloucestershire). We aimed to recruit 60 participants in 15 months, referred to supported accommodation, randomly allocated on an equal basis to receive either a local supported housing or floating outreach service. We assessed referrals to the trial, participants recruited, attrition, time from recruitment to moving into either type of supported accommodation, and feasibility of masking. We conducted a process evaluation to examine our results further. Results: We screened 1,432 potential participants, of whom 17 consented to participate, with 8 agreeing to randomisation (of whom 1 was lost to attrition) and 9 participating in naturalistic follow-up. Our process evaluation indicated that the main obstacle to recruitment was staff and service user preferences for certain types of supported accommodation or for specific services. Staff also felt that randomisation compromised their professional judgement. Conclusions: Our results do not support investment in a large-scale trial in England at this time. Trial registration: UK CRN Portfolio database, Trial ID: ISRCTN19689576. Trial funding: National Institute of Health Research (RP-PG-0707-10093).
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Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Zohra Zenasni
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Paul McCrone
- King's Health Economics, King's College London, London, United Kingdom
| | - Sarah Dowling
- Division of Psychiatry, University College London, London, United Kingdom
| | - Isobel Harrison
- Division of Psychiatry, University College London, London, United Kingdom
| | - Joanna Krotofil
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Rose McGranahan
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Maurice Arbuthnott
- North London Service User Research Forum, Division of Psychiatry, University College London, London, United Kingdom
| | - Sarah Curtis
- Department of Geography, Durham University, Durham, United Kingdom
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, University of Ulster, Londonderry, United Kingdom
| | - Rob MacPherson
- 2Gether NHS Foundation Trust, Gloucester, United Kingdom
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
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7
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Richter D, Hoffmann H. Preference for Independent Housing of Persons with Mental Disorders: Systematic Review and Meta-analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:817-823. [PMID: 28160182 DOI: 10.1007/s10488-017-0791-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Choice of housing has become an important political and therapeutic goal for psychiatric rehabilitation. We conducted a systematic review and meta-analysis of proportions of studies on preference for independent housing. A subgroup analysis compared studies with homeless and non-homeless consumers. The meta-analysis included 8 studies with 3134 consumers. The overall proportion of consumers who had expressed a preference for living independently was 0.84. There were only marginal differences between studies with homeless and non-homeless consumers. In a given service planning area, the rate of independent housing settings should exceed the rate of more institutionalized settings by a wide margin.
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Affiliation(s)
- Dirk Richter
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland. .,School of Health Sciences, Bern University of Applied Sciences, Bern, Switzerland.
| | - Holger Hoffmann
- Center for Psychiatric Rehabilitation, University Bern Psychiatric Services, Murtenstrasse 46, 3008, Bern, Switzerland.,Soteria Clinic, Bern, Switzerland
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8
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Macpherson R, Calciu C, Foy C, Humby K, Lozynskyj D, Garton C, Steer H, Elliott H. A service evaluation of outcomes in two in-patient recovery units. BJPsych Bull 2017; 41:330-336. [PMID: 29234510 PMCID: PMC5709682 DOI: 10.1192/pb.bp.116.055137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims and method To evaluate outcomes for patients during their admission or in the first year of treatment in two in-patient recovery units. Changes in health and social functioning, service use and need (rated by patients and staff) were evaluated. Results In 43 patients treated, there was a large (30%) increase in patients discharged to their own tenancies, rather than supported accommodation. There was minimal change in Health of the Nation Outcome Scales (HoNOS) scores in the course of the admission but staff- and patient-rated unmet needs reduced and met needs increased. Needs changed mainly in domains relating to social functioning. Reductions in risk to self and others were rated by staff but not patients. There were no cases of patients being readmitted to acute hospital during the study period. Clinical implications Although these results offer some support to the treatment approach described in these in-patient recovery units, further research in larger samples is needed to identify how these services can best be deployed to help individuals with severe mental illness and complex needs.
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Affiliation(s)
| | | | - Chris Foy
- Gloucestershire Hospitals NHS Foundation Trust
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9
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Brolin R, Syrén S, Rask M, Sandgren A, Brunt D. Residents' perceptions of the most positive and negative aspects of the housing situation for people with psychiatric disabilities. Scand J Caring Sci 2017; 32:603-611. [DOI: 10.1111/scs.12485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rosita Brolin
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - Susanne Syrén
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - Anna Sandgren
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - David Brunt
- Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
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10
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Sandhu S, Priebe S, Leavey G, Harrison I, Krotofil J, McPherson P, Dowling S, Arbuthnott M, Curtis S, King M, Shepherd G, Killaspy H. Intentions and experiences of effective practice in mental health specific supported accommodation services: a qualitative interview study. BMC Health Serv Res 2017; 17:471. [PMID: 28693490 PMCID: PMC5504783 DOI: 10.1186/s12913-017-2411-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 06/27/2017] [Indexed: 11/19/2022] Open
Abstract
Background Deinstitutionalisation in Europe has led to the development of community-based accommodation for people with mental health problems. The type, setting, and intensity of support provided vary and the costs are substantial. Yet, despite the large investment in these services, there is little clarity on their aims and outcomes or how they are regarded by staff and the clients. Methods We interviewed 30 staff and 30 clients from the three main types of supported accommodation in England (residential care, supported housing, floating outreach) to explore their perspectives on the purpose of these services, and the components of care considered most helpful. The interviews were coded and analysed using thematic analysis. Results There were generally consistent understandings amongst clients and staff across service types on the goals and purposes of supported accommodation services as: building independence and confidence; supporting people with their mental health; and providing safety and stability. We also noted a competing theme of anxiety about the continuity of support when clients move on from a service. Themes on the experience of what aided effective practice centred on: the supportive presence of others; incremental steps to progress; working together to avoid deskilling and dependency; feeling known and personally understood; tailoring support for social and community engagement; and building confidence through encouragement. Conclusions The findings provide an understanding of the commonalities in service approach, and goals of clients in these services, as well as the facilitators of goal attainment. However, they also highlight a common tension between providing safe and supportive living environments, whilst also promoting independence and facilitating rehabilitative change.
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Affiliation(s)
- Sima Sandhu
- Unit for Social and Community Psychiatry, WHO Collaborative Centre for Mental Health Services Development, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborative Centre for Mental Health Services Development, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Derry, Northern Ireland
| | - Isobel Harrison
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Joanna Krotofil
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Peter McPherson
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Sarah Dowling
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Maurice Arbuthnott
- North London Service User Research Forum, Division of Psychiatry, University College London, Maple House, London, UK
| | - Sarah Curtis
- Department of Geography, Durham University, Durham, UK
| | - Michael King
- Division of Psychiatry, University College London, Maple House, London, UK
| | - Geoff Shepherd
- Implementing Recovery through Organisational Change, Mental Health Network NHS Confederation, London, UK
| | - Helen Killaspy
- Division of Psychiatry, University College London, Maple House, London, UK
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11
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Rask M, Schröder A, Lundqvist LO, Ivarsson AB, Brunt D. Residents' View of Quality in Ordinary Housing with Housing Support for People with Psychiatric Disabilities. Issues Ment Health Nurs 2017; 38:132-138. [PMID: 27936987 DOI: 10.1080/01612840.2016.1253806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to investigate the quality of housing support provided in housing services for people with psychiatric disabilities living in ordinary housing with housing support from the residents' perspective, by using the QPC-H instrument. A sample of 174 residents in ordinary housing, receiving housing support from 22 housing support services in nine Swedish municipalities, participated in this study. The results show that the quality of psychiatric care in housing services was mainly rated highly as measured with the QPC-H instrument. The dimensions Encounter and Secluded Environment were the aspects that were rated as the two with the highest quality of housing service. The dimensions Participation and Secure Environment were rated as those with the lowest quality. There were more residents who totally disagreed with the statements in the dimensions Participation and Housing Specific than in the other dimensions. The perceived lower quality in Encounter, Participation, Support and the Housing Specific dimensions was associated with a low frequency of psychiatric outpatient clinic contacts. A conclusion is that the support staff could be more observant regarding the residents' need for support and also talk more with them about what could be done to assist them. It also seems important that the support staff discuss with the residents regarding how they can help them to feel more secure in their accommodation.
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Affiliation(s)
- Mikael Rask
- a Linnaeus University, School of Health and Caring Sciences , Växjö , Sweden
| | - Agneta Schröder
- c Örebro University, University Health Care Research Center, Faculty of Medicine and Health, Örebro, Sweden Norwegian University of Science and Technology (NTNU), Department of Nursing, Faculty of Health, Care and Nursing , Gjövik , Norway
| | - Lars-Olov Lundqvist
- b Örebro University, University Health Care Research Center, Faculty of Medicine and Health , Örebro , Sweden
| | - Ann-Britt Ivarsson
- d Örebro University, School of Health and Medical Sciences , Örebro , Sweden
| | - David Brunt
- a Linnaeus University, School of Health and Caring Sciences , Växjö , Sweden
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"The Apartment is for You, It's Not for Anyone Else": Managing Social Recovery and Risk on the Frontlines of Single-Adult Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 45:152-162. [PMID: 27900616 DOI: 10.1007/s10488-016-0780-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This multi-method qualitative study examines frontline provider perspectives on consumer social relationships and barriers to social recovery in supportive housing programs for adults with serious mental illness. Thematic analyses show that guest and occupancy policies that enforce the "single" nature of single-adult supportive housing challenge consumer rights to self-determination in the realm of social recovery. Findings also highlight the ways in which providers act to reinforce and subvert these policies while mitigating risk in this service setting. Recommendations for enhancing the recovery orientation of supportive housing and implications for the design of the homeless service system are discussed.
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Salem L, Crocker AG, Charette Y, Earls CM, Nicholls TL, Seto MC. Housing Trajectories of Forensic Psychiatric Patients. BEHAVIORAL SCIENCES & THE LAW 2016; 34:352-365. [PMID: 27138216 DOI: 10.1002/bsl.2223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/15/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
The objectives of this study were to describe the disposition and housing trajectories of individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD), and the factors that predict different trajectories. To do so, disposition and housing status were coded for 934 NCRMD patients over a 36-month follow-up period. Sequential data analysis resulted in four distinct trajectories: detention in hospital, conditional discharge in supportive housing, conditional discharge in independent housing, and absolute discharge to unknown housing. The likelihood of a placement in supportive housing compared with detention significantly decreased for individuals with a higher index offense severity. Less restrictive trajectories were significantly predicted by clinical factors. The results revealed little change in the disposition and housing trajectories of NCRMD patients. Furthermore, decisions about disposition and housing placement reflect a knowledge-practice gap between risk factors known to be predictive of community resources use in the forensic population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Leila Salem
- Université de, Montréal, QC, Canada
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Anne G Crocker
- Douglas Mental Health University Institute, Montréal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Yanick Charette
- Douglas Mental Health University Institute, Montréal, QC, Canada
- Yale University, New Haven, CT
| | | | - Tonia L Nicholls
- University of British Columbia & British Columbia Mental Health & Substance Use Services, Vancouver, BC, Canada
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14
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Brolin R, Rask M, Syrén S, Baigi A, Brunt DA. Satisfaction with housing and housing support for people with psychiatric disabilities. Issues Ment Health Nurs 2015; 36:21-8. [PMID: 25397858 DOI: 10.3109/01612840.2014.930216] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the degree of satisfaction with housing and housing support for people with psychiatric disabilities in Sweden. A total of 370 residents, in supported housing and in ordinary housing with housing support, completed a new questionnaire and reported a high degree of overall satisfaction, but many of them wanted to move somewhere else. Differences were found between the two different types of housing concerning satisfaction with housing support, social life and available choices. Security and privacy, as well as other's influence on the choice of residential area and dwelling proved to be important predictors for satisfaction.
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Affiliation(s)
- Rosita Brolin
- School of Health and caring Sciences, Linnaeus University, Växjö, Sweden
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15
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Stergiopoulos V, Gozdzik A, O'Campo P, Holtby AR, Jeyaratnam J, Tsemberis S. Housing First: exploring participants' early support needs. BMC Health Serv Res 2014; 14:167. [PMID: 24725374 PMCID: PMC4021373 DOI: 10.1186/1472-6963-14-167] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrollment in a Canadian field trial of Housing First. METHODS The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis. RESULTS The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrollment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support. CONCLUSIONS Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs. TRIAL REGISTRATION Current Controlled Trials ISRCTN42520374.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St, Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
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16
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Chen FP, Herman DB. Discharge practices in a time-unlimited intervention: the perspectives of practitioners in assertive community treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 39:170-9. [PMID: 21472483 DOI: 10.1007/s10488-011-0344-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Assertive Community Treatment (ACT) model for people with severe mental illness has typically been viewed as a time-unlimited intervention. Without a proscribed service duration, discharge from ACT largely depends on individual clients' situations and practitioners' discretion. We conducted semi-structured focus groups and interviews with practitioners to explore their discharge practices and considerations. Results highlight the heterogeneity of the clientele served in ACT, and therefore the importance of individualized treatment and discharge planning, guidance on assessing the timing of discharge for individual cases, practice strategies that balance independence and social connectedness to promote recovery, and the need for substantial system reform to facilitate transition after discharge.
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Affiliation(s)
- Fang-Pei Chen
- Columbia University School of Social Work, New York, NY 10027, USA.
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17
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Piat M, Boyer R, Cloutier S, Fleury MJ, Lesage A. Les conditions d’hébergement favorables au rétablissement : perspective des usagers et usagères. CANADIAN JOURNAL OF COMMUNITY MENTAL HEALTH = REVUE CANADIENNE DE SANTE MENTALE COMMUNAUTAIRE 2012; 31:67-85. [PMID: 27099410 PMCID: PMC4835238 DOI: 10.7870/cjcmh-2012-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study is to better understand the role of housing in the recovery of people living with severe mental illness. Forty residents of various kinds of structured community housing facilities were questioned about housing conditions that were favourable to their recovery. The results indicate that, for the residents, material conditions have a determining influence on recovery. Their concerns are related to basic needs such as food, costs, conveniences and quality of housing. Social relationships with their immediate circle also have a strong influence on people's recovery, and they want above all to preserve the modest gains that they have made, both material and social. This stability is a prerequisite for their recovery.
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Affiliation(s)
- Myra Piat
- Université McGill et Institut universitaire en santé mentale Douglas
| | - Richard Boyer
- Université de Montreal et Centre de recherche Fernand-Séguin de l'hôpital Louis-H. Lafontaine
| | | | | | - Alain Lesage
- Université de Montreal et Centre de recherche Fernand-Séguin de l'hôpital Louis-H. Lafontaine
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18
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Johansson M, Brunt D. The physical environment of purpose-built and non-purpose-built supported housing for persons with psychiatric disabilities in Sweden. Issues Ment Health Nurs 2012; 33:223-35. [PMID: 22468588 DOI: 10.3109/01612840.2011.647254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The primary aim of the present study was to investigate if methods derived from environmental psychology can be used to study the qualities of the physical environment of supported housing facilities for persons with psychiatric disabilities. Three units of analysis were selected: the private area, the common indoor area, and the outdoor area. Expert assessments of 110 features of the physical environment in these units and semantic environmental description of the visual experience of them consistently showed that purpose-built supported housing facilities had more physical features important for high quality residential environments than the non-purpose-built supported housing facilities. The employed methods were thus seen to be able to describe and discriminate between qualities in the physical environment of supported housing facilities. Suggestions for the development of tools for the assessment of the physical environment in supported housing are made.
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Affiliation(s)
- Maria Johansson
- Environmental Psychology, Department of Architecture and Built Environment, Lund University, Lund, Sweden.
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19
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Copeland DA, Heilemann MV. Choosing "the best of the hells": mothers face housing dilemmas for their adult children with mental illness and a history of violence. QUALITATIVE HEALTH RESEARCH 2011; 21:520-533. [PMID: 21041518 PMCID: PMC4631607 DOI: 10.1177/1049732310387936] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Family members in the United States--especially mothers--are frequently caregivers, and provide housing for their adult relatives and children with mental illness. They often do so with little support from the mental health system. The purpose of this analysis was to explore mothers' experiences related to housing options available to their adult children with a mental illness and a history of violence (MIHV) toward the mothers. The results of this study reveal a complex mixing of desires, feelings, internal factors, and external forces experienced by mothers of adult children with MIHV when considering whether or not these children can live in their homes. The findings from this study illuminate needs for greater familial involvement in mental health treatment decisions, respite for caregiving families, and housing as a crucial element of a comprehensive mental health treatment plan.
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20
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Tabol C, Drebing C, Rosenheck R. Studies of "supported" and "supportive" housing: a comprehensive review of model descriptions and measurement. EVALUATION AND PROGRAM PLANNING 2010; 33:446-56. [PMID: 20138365 DOI: 10.1016/j.evalprogplan.2009.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 05/05/2023]
Abstract
Supported housing is a service model that couples provision of independent housing with provision of community-based supports for individuals with psychiatric disabilities at risk of homelessness. Despite its promise as an alternative to traditional sequential residential rehabilitation programs, supported housing has not been evaluated to an extent that supports firm conclusions concerning the efficacy of specific program elements. We conducted a comprehensive review of the literature on supported housing and similarly labeled programs, to determine the degree of clarity in the supported housing model and the degree of fidelity to that model within the empirical literature, and to determine whether lack of clarity or fidelity are barriers to widespread, systematic program implementation and evaluation. We encountered a number of limitations in the literature, including conflicting use of program labels, inconsistent definitions of supported housing and its elements, and use of inadequate measurement indices in assessing adherence to program elements. Our findings suggest that greater model clarity, better specification of model elements, and greater standardization in measurement of program dimensions would aid in supported housing program implementation and evaluation. We present a number of recommendations for the field and suggestions for future research.
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Affiliation(s)
- Charity Tabol
- Mental Illness, Research and Education Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA.
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21
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Tsai J, Bond GR, Davis KE. Housing Preferences among Adults with Dual Diagnoses in Different Stages of Treatment and Housing Types. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2010; 13:258-275. [PMID: 21415937 PMCID: PMC3057217 DOI: 10.1080/15487768.2010.523357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Housing is an essential component of psychiatric rehabilitation, particularly for consumers with dual diagnoses. Research has not clearly examined why and when consumers prefer different types of housing. This exploratory study examined 1) whether housing preferences differ between stage of treatment for substance abuse, 2) whether consumers who prefer certain housing types have preferences for certain characteristics, and 3) whether consumers living in different types of housing report differences in social support, choice, and housing satisfaction. A total of 103 participants living in supervised housing (n= 65), independent apartment housing (n= 22), single room occupancy hotels (n= 11), and with family (n= 5) completed self-report questionnaires. Results showed that 1) the majority of participants preferred their own apartment or house across different stages of treatment, 2) preference for supervised housing was associated with on-site staff and peer support while preference for apartment housing was associated with autonomy and privacy, and 3) consumers in single room occupancies reported the least choice and lowest satisfaction. These findings contribute to the understanding of consumers' housing preferences and the differences consumers perceive between certain housing types.
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Affiliation(s)
- Jack Tsai
- Department of Psychiatry, Yale University, New Haven, CT 06516
| | - Gary R. Bond
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, NH 03766
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22
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Tsai J, Bond GR, Salyers MP, Godfrey JL, Davis KE. Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study. Community Ment Health J 2010; 46:381-8. [PMID: 19898935 PMCID: PMC2891397 DOI: 10.1007/s10597-009-9268-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 10/24/2009] [Indexed: 11/29/2022]
Abstract
Housing is a crucial issue for adults with severe mental illness and co-occurring substance use disorders, as this population is particularly susceptible to housing instability and homelessness. We interviewed 40 adults with dual disorders, living in either supervised or independent housing arrangements, to examine housing preferences, decision making processes surrounding housing choices, and perceived barriers to housing. We found that many clients indicated their housing preferences had changed over time, and some clients related housing preferences to recovery. Although the majority of clients preferred independent housing, many also described benefits of supervised housing. Clients' current living situations appeared to be driven primarily by treatment provider recommendations and availability of housing. Common barriers to obtaining desired housing were lack of income and information. These findings have implications for supported housing models and approaches to providing housing for clients.
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Affiliation(s)
- Jack Tsai
- Indiana University-Purdue University, Indianapolis, IN 46202, USA.
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23
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Weiner A, Roe D, Mashiach-Eizenberg M, Baloush-Kleinman V, Maoz H, Yanos PT. Housing model for persons with serious mental illness moderates the relation between loneliness and quality of life. Community Ment Health J 2010; 46:389-97. [PMID: 20035384 DOI: 10.1007/s10597-009-9279-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 12/08/2009] [Indexed: 11/24/2022]
Abstract
This study compared levels of loneliness, quality of life (QOL) and social support among people with serious mental illness (SMI) living in two different types of housing: group homes and supportive community housing. Forty persons with SMI living in supportive community housing and 57 living in a group home completed measures of QOL, symptoms, perceived social support and loneliness. Analysis of variance tests were conducted to examine whether there were differences in degree of loneliness, QOL and social support between the groups living in the two residential types. No significant differences between the two housing models were found. Correlational analysis, however, indicated a strong relationship between loneliness and QOL. Subsequent regression analysis revealed that residence in group homes moderates the relationship between social loneliness and QOL, such that social loneliness impacted QOL only among group home residence. Implications of the findings for understanding the impact of housing on QOL are discussed.
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Affiliation(s)
- Adi Weiner
- Department of Community Mental Health, University of Haifa, Haifa, Israel.
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24
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Chen FP. Assisting adults with severe mental illness in transitioning from parental homes to independent living. Community Ment Health J 2010; 46:372-80. [PMID: 19898987 DOI: 10.1007/s10597-009-9263-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
This study explores mental health professionals' practices with adult clients and their parents at the departure of the clients' transition from the parental home to independent living. Using grounded theory methodology, the author interviewed 24 case managers in Assertive Community Treatment programs in Wisconsin and applied dimensional analysis to identify and categorize concepts in verbatim transcripts. Different client-parent relationships were sampled to compare practices on client independent living. Results show that case managers considered client independent living a desirable social norm and a practical approach to addressing long-term care concerns. Based on the status of parental approval of independent living, case managers applied various strategies to foster helpful parental emotional boundaries with clients in order to facilitate client independence. The author discussed implications for practice and suggested future research on clients' and parents' perspectives on independent living and the short-term and long-term effects of the transition on their well-being.
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Affiliation(s)
- Fang-Pei Chen
- Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027, USA.
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25
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Piat M, Lesage A, Dorvil H, Boyer R, Couture A, Bloom D. Les préférences résidentielles des personnes souffrant de troubles mentaux graves : une étude descriptive. SANTE MENTALE AU QUEBEC 2009; 33:247-69. [DOI: 10.7202/019677ar] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Résumé
Cet article présente les résultats d’une étude exploratoire portant sur les préférences résidentielles de 315 personnes souffrant de troubles mentaux graves hébergées dans sept types d’hébergement à Montréal. Le portrait d’ensemble qui se dégage de cette étude met en évidence que 22,0 % des usagers préféreraient habiter dans leur propre appartement, 16,0 % dans les HLM ou OSBL, 14,1 % dans les appartements supervisés et 11,5 % dans les ressources de type familial. On note aussi que 31,7 % d’entre eux préfèrent le type de logement dans lequel ils habitaient au moment de l’étude. Notre réflexion sur les résultats de cette étude nous amène à conclure qu’une variété de types de ressources résidentielles demeure nécessaire pour rencontrer la diversité de besoins des usagers.
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Affiliation(s)
- Myra Piat
- Ph.D., Chercheur, Centre de recherche de l’Hôpital Douglas ; Professeur adjoint, Départements de psychiatrie, Faculté de médecine, Université McGill
| | - Alain Lesage
- MD., Professeur titulaire au Département de psychiatrie de l’Université de Montréal ; Chercheur, Centre de recherche Fernand-Seguin de l’Hôpital Louis-H. Lafontaine
| | - Henri Dorvil
- Ph.D., Professeur titulaire, École de travail social de l’UQAM ; Chercheur, Groupe de recherche sur les aspects sociaux de la santé et de la prévention (GRASP), Université de Montréal ; Chercheur, Centre de recherche Fernand-Seguin de l’Hôpital Louis-H. Lafontaine
| | - Richard Boyer
- Ph.D., Chercheur agréé, Département de psychiatrie de l’Université de Montréal ; Chercheur agréé, Centre de recherche Fernand-Seguin de l’Hôpital Louis-H. Lafontaine
| | - Audrey Couture
- MSc., Coordonnatrice de recherche, Centre de recherche de l’Hôpital Douglas
| | - David Bloom
- MD, Chef médical, Chef médical de programme des troubles psychotiques ; Chercheur clinique, Hôpital Douglas
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Wong YLI, Poulin SR, Lee S, Davis MR, Hadley TR. Tracking residential outcomes of supported independent living programs for persons with serious mental illness. EVALUATION AND PROGRAM PLANNING 2008; 31:416-426. [PMID: 18762339 DOI: 10.1016/j.evalprogplan.2008.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 05/30/2008] [Accepted: 07/07/2008] [Indexed: 05/26/2023]
Abstract
This study seeks to document patterns and reasons of leaving housing, and identify factors associated with different types of exits for a cohort of 452 residents with serious mental illness entering supported independent living (SIL) in Philadelphia, PA. The study cohort was tracked through an integrated administrative database comprised information on basic demographic and clinical characteristics, length of stay, homeless shelter use, and publicly funded behavioral health services use. A convenience sample of 46 SIL leavers and their support staff provided data on scenarios of leaving. The findings of this study suggest that departure from SIL is not a unitary phenomenon, but involving plausibly favorable as well as unfavorable circumstances. Multivariate analysis based on administrative tracking data suggests demographic and clinical factors, housing setting, and service use factors to have effects on leaving SIL and distinct types of exit examined in this study. Data procured from the convenience sample highlight the potential roles that program rules and resident-staff relationships play in affecting housing tenure. Implications of the findings for the development of permanent supportive housing for persons with serious mental illness are discussed.
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Affiliation(s)
- Yin-Ling Irene Wong
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214, USA
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27
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Sylvestre J, Nelson G, Sabloff A, Peddle S. Housing for people with serious mental illness: a comparison of values and research. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2007; 40:125-37. [PMID: 17587174 DOI: 10.1007/s10464-007-9129-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This article contrasts values associated with the delivery of housing programs for people with serious mental illness with the typical topics pertaining to housing that are studied by researchers. Six values were identified through a search and content analysis of the literature on housing for people with serious mental illness. A second review of the literature was conducted to identify research on housing for this population. A comparison of findings from the two reviews suggested that whereas values concerned with the therapeutic benefits of housing had received considerable research attention, those concerned with a citizenship dimension had received relatively little. The findings are discussed in terms of their implications for the delivery of housing services and for housing research.
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Affiliation(s)
- John Sylvestre
- School of Psychology, University of Ottawa, 125 University Street, Ottawa, ON, Canada.
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28
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Depla MFIA, De Graaf R, Heeren TJ. The relationship between characteristics of supported housing and the quality of life of older adults with severe mental illness. Aging Ment Health 2006; 10:592-8. [PMID: 17050088 DOI: 10.1080/13607860600641135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined whether group living (as opposed to single living), staff availability and degree of personal freedom are associated with the quality of life of older adults with severe mental illness. A cross-sectional study was carried out in 18 supported living programmes in residential homes for the elderly that differed in terms of these three characteristics. The study included 35 patients with a psychotic disorder and 38 with an anxiety or mood disorder. Quality of life was assessed with the Philadelphia Geriatric Centre Morale Scale (PGCMS) and the Manchester Short Assessment of Quality of Life (MANSA). No association was found between group living and quality of life. Availability of psychiatrically trained staff was associated with life quality only for patients with a psychotic disorder, and perceived amount of personal freedom was associated with life quality only for patients with a non-psychotic disorder. Both differences were seen only on the PGCMS Agitation subscale. Older people with psychotic disorders appear to have relatively high needs for professional psychiatric support, and those with non-psychotic disorders for control over their daily lives. Further research is needed in other settings for older people with severe mental illness, preferably using longitudinal designs.
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Affiliation(s)
- M F I A Depla
- Netherlands Institute of Mental Health and Addiction Trimbos-instituut, Utrecht, The Netherlands.
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Forchuk C, Nelson G, Hall GB. "It's important to be proud of the place you live in": housing problems and preferences of psychiatric survivors. Perspect Psychiatr Care 2006; 42:42-52. [PMID: 16480416 DOI: 10.1111/j.1744-6163.2006.00054.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
TOPIC It is important to understand housing and mental health issues from the perspective of psychiatric survivors. This paper reports findings from a series of focus group meetings held with survivors of mental illness to address issues concerning housing preferences and housing needs. METHODS The discussions were recorded, transcribed, and analyzed using an ethnographic method of analysis. The themes that emerged related to oppression, social networks and social supports, housing conditions, poverty and finances, and accessing services. Participants described the ongoing stigma, discrimination, and poverty that reduced their access to safe, adequate housing. FINDINGS They preferred independent housing where supports would be available as needed. Participants described the dilemma of having to choose between the housing they wanted and the supports they needed, since supports were often contingent upon living in a less desirable housing situation. CONCLUSIONS Nurses and other mental healthcare workers need to be aware of these issues for discharge planning, community support, and ongoing advocacy. The survivor voices need to be heard by decision-makers at various levels of government in order for housing policy to become more receptive to their realities.
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Affiliation(s)
- Cheryl Forchuk
- University of Western Ontario/Lawson Health Research Institute, London, ON, Canada.
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Santone G, de Girolamo G, Falloon I, Fioritti A, Micciolo R, Picardi A, Zanalda E. The process of care in residential facilities--a national survey in Italy. Soc Psychiatry Psychiatr Epidemiol 2005; 40:540-50. [PMID: 16088373 DOI: 10.1007/s00127-005-0922-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics. METHODS Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments. RESULTS Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients' daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables. CONCLUSIONS This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients' needs.
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Affiliation(s)
- Giovanni Santone
- United Hospitals of Ancona, Politechnic University of Marche Ancona, Italy
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Ward-Griffin C, Schofield R, Vos S, Coatsworth-Puspoky R. Canadian families caring for members with mental illness: a vicious cycle. JOURNAL OF FAMILY NURSING 2005; 11:140-61. [PMID: 16287823 DOI: 10.1177/1074840705275464] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The purpose of this qualitative, descriptive study was to explore the perspectives of individuals who were caring for a family member with a mental illness, with particular attention to housing, quality of supports, and formal care services. Eleven focus groups with family caregivers (N = 75) were conducted. Both individual and team thematic analyses were undertaken until interpretations of the experiences of the participants were inductively developed and conceptualized into a holistic interpretation. Findings revealed that family caregivers were part of a "circle of care," supporting the independence of the individual with mental illness while attempting to protect their family member with mental illness. However, findings suggested that this circle of care led to a "vicious cycle" of caregiving. Three major themes were identified: witnessing inadequacies, working behind the scenes, and creating a better world. Health-promoting family nursing practice and policy implications, as well as areas for further research, are discussed.
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Affiliation(s)
- Catherine Ward-Griffin
- School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Ontario N6A 5C1, Canada.
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Abstract
AIM This study assessed the goals 'new' long-stay clients aim to achieve by being in supported housing (SH), compared the goals stated by clients and staff, and tested whether subgroups of clients can be identified on the basis of their goals, quality of life and psychopathology. METHOD Interviews were conducted with 41 clients and 39 staff of supported houses in London and Essex, UK. Descriptive, content and cluster analyses were used to analyse the results. RESULTS Clients' most frequently reported goal was moving to independent housing, followed by staying healthy, and increasing living skills. A comparison of goals reported by clients and staff showed poor or no agreement between them. Cluster analyses identified two clusters of clients. Cluster A (n = 23) contained those with no stated goals (or with the aim of staying healthy), lower quality of life, and more psychopathology; cluster B (n = 18) included those with an aim to move to independent housing, better quality of life, and less psychopathology. CONCLUSION In the UK, more staff training may be needed to identify and achieve the goals of the 'new' long-stay clients. For a subgroup of these clients, SH may still be a long-term care setting; while for another subgroup, new forms of rehabilitation in SH and better opportunities to leave SH may have to be developed. More conceptual and practical efforts are needed to manage the transformation of many settings from homes for life to transitional places where residents receive specific interventions.
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Affiliation(s)
- Walid K H Fakhoury
- Unit for Social and Community Psychiatry of St Bartholomew's and the Royal London School of Medicine (Queen Mary, University of London), Newham Centre for Mental Health, UK.
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van Weeghel J, van Audenhove C, Colucci M, Garanis-Papadatos T, Liégeois A, McCulloch A, Muijen M, Norcio B, Ploumbidis D, Bauduin D. The components of good community care for people with severe mental illnesses: views of stakeholders in five European countries. Psychiatr Rehabil J 2005; 28:274-81. [PMID: 15690741 DOI: 10.2975/28.2005.274.281] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Researchers and practitioners collaborated in a project across five European countries aimed at defining the characteristics of good community care for people with severe mental illnesses and to explore the values ofstakeholders in this debate (clients, families, professionals, policy makers, other citizens). In a concept mapping procedure all stakeholders gave highest priority to a trusting and stimulating relationship between clients and professionals. Secondly, good care was seen as effective treatment tailored to the individual needs. Accessibility of services came in the third place. Differences between the views of stakeholders are discussed.
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Affiliation(s)
- Jaap van Weeghel
- Continuing Care Research Department, Trimbos Institute, The Netherlands.
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Freeman A, Malone J, Hunt GE. A statewide survey of high-support services for people with chronic mental illness: assessment of needs for care, level of functioning and satisfaction. Aust N Z J Psychiatry 2004; 38:811-8. [PMID: 15369540 DOI: 10.1080/j.1440-1614.2004.01466.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The primary aim of this study was to describe high support accommodation services available for patients with chronic mental illness living in New South Wales (NSW). The second aim was to ask patients in these facilities about their needs and satisfaction with services and to assess their level of functioning. METHOD Non-inpatient services matching NSW Health's definition for high support, very high support and residential rehabilitation were sent a survey regarding type of service, criteria for acceptance, choice of housing options, patient demographics, evaluation methods and staff details. The Camberwell Assessment of Need was used to assess needs and the Life Skills Profile-16 was used to assess level of functioning. Comparisons were made between services operated by NSW Health and non-government organizations (NGOs), rural and urban services and services providing 24-hour support and those with less intensive staffing. RESULTS Forty of the 42 identified services were included in the survey (95% response rate) of which 25 were operated by NGOs. There were 753 residential beds and 1132 patients lived in these facilities over the financial year 2001/2002. Interviews were completed at 25 locations across the state with 159 patients. Seventy-four percent were male and the mean age was 43 years. Patients had on average 7.6 needs of which 2.2 were unmet and their mean LSP-16 total score was 16.8. Almost half the patients responded that they were homeless at one time because they could not find appropriate housing. CONCLUSIONS There were no significant differences in the number of needs expressed by patients residing in government or non-government operated services, those living in rural or urban areas and those in 24-hour services compared to patients in less intensively staffed services. Existing services are doing a good job of meeting patients' needs for practical assistance, but social and psychological needs remain unmet for a significant proportion.
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Piat M, Perreault M, Lacasse D, Ioannou S, Pawliuk N, Bloom D. Stakeholder perspectives on psychiatric foster homes: residents, families, caregivers, and professionals. Psychiatr Rehabil J 2004; 27:228-34. [PMID: 14982329 DOI: 10.2975/27.2004.228.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eight focus groups were conducted with the stakeholders involved in psychiatric foster homes: people with psychiatric disabilities, families, caregivers, and professionals. Four content dimensions emerged as important: 1) foster home environment, 2) caregiver characteristics, 3) community integration, and 4) stakeholder relationships. Findings revealed different perspectives among stakeholders. Caregivers and professionals differed in their views on rehabilitation. Families wanted stricter controls within homes; residents appreciated more autonomy. While residents and caregivers focussed on integration within the foster home, professionals criticized the lack of community integration. These findings demonstrate the need to examine the perspectives of multiple stakeholders in order to present a complete view of psychiatric foster homes.
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Affiliation(s)
- Myra Piat
- Division of Specialized and Continuing Care for Adults, Douglas Hospital, Quebec, Canada.
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Nelson G, Hall GB, Forchuk C. Current and Preferred Housing of Psychiatric Consumers/Survivors. ACTA ACUST UNITED AC 2003; 22:5-19. [PMID: 15462577 DOI: 10.7870/cjcmh-2003-0001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As part of a participatory action research project, we surveyed 300 psychiatric consumers/survivors from southwestern Ontario regarding their housing preferences and housing satisfaction. We found that, while 79% of the sample preferred independent living, 76% were living in some other type of setting (e.g., temporary shelter, supportive housing, sheltered care). Those living in temporary shelters reported the lowest levels of housing satisfaction, and those who were living in the type of housing that they preferred had the highest levels of housing satisfaction. This information is being used by stakeholder groups involved in the project to help build the capacity of the community to provide the types of housing that are preferred by consumers/survivors.
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