Care of patients with chronic mental illness: comparison of home and half-way house care

The level of formal support received by people with severe mental illness living in supported accommodation and participation: A systematic review

AIM

The review aimed to identify and explore the association of level of support received by people with severe mental illness in supported accommodation and participation.

METHOD

The authors conducted a systematic search in MEDLINE, PsychINFO, PsychARTICLES, CINAHL Plus and ASSIA. Searches were restricted to articles published in English and participants aged 18 years and over with severe mental illness. Articles were included based on level of support received in mental health supported accommodation, classified according to the Simple Taxonomy for Supported Accommodation, and three factors of participation: social participation, daily living functioning and personal empowerment. Studies of in-patient settings and nursing homes were excluded. The review protocol is registered on PROSPERO (registration number: CRD42019161808).

RESULTS

Six articles were included in the review from USA, Australia, Sweden and Taiwan. Factors of participation for people living in accommodation with moderate support and accommodation with high support were explored. Data indicated an association between level of support and participation showing that people living in accommodation with moderate support had increased participation compared to people living in accommodation with high support.

CONCLUSION

This review identified an association between level of formal support and participation. People with SMI living in accommodation with medium support participated in more community occupations, more activities and had a higher level of personal empowerment than people living in accommodation with high support.

Patients' perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study

OBJECTIVE

The aim of this study is to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan.

METHODS

Qualitative semi-structured interviews were used to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. Individual semi-structured interviews were conducted from July to August 2017 with a purposive sample of twenty patients using halfway houses. Data were analysed using thematic analysis.

RESULTS

Analysis of the interviews identified two themes: barriers to shared decision making; facilitators of shared decision making. Patients perceived that they were not involved in decision making due to: the professional status of health professionals; negative perception of making decisions; and limited time resources. However, patients reported a desire to be involved and felt sufficient information exchange would be a necessary step towards collaboration/sharing decisions about treatment with clinicians.

CONCLUSION

The findings provided an understanding of significant barriers to and facilitators of implementing shared decision making to aid further professional training and the development of national policies.

PRACTICE IMPLICATIONS

The findings could be the basis for developing effective strategies to overcome barriers to shared decision making and improve the process quality of delivering shared decision making.

Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes

BACKGROUND

Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services.

METHODS

Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: 'Homeless', 'Deinstitutionalisation' and 'General Severe Mental Illness (SMI)'.

RESULTS

Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research.

CONCLUSIONS

A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

Inconsistent terminology and variation in service models have made synthesis of the supported accommodation literature challenging. To overcome this, we developed a brief, categorical taxonomy that aimed to capture the defining features of different supported accommodation models: the simple taxonomy for supported accommodation (STAX-SA). Data from a previous review of existing classification systems were used to develop the taxonomy structure. After initial testing and amendments, the STAX-SA and an existing taxonomy were applied to 132 supported accommodation service descriptions drawn from two systematic reviews and their performance compared. To assess external validity, the STAX-SA was distributed to a sample of supported accommodation managers in England and they were asked to use it to classify their services. The final version of the STAX-SA comprised of five supported accommodation 'types', based on four domains; Staffing location; Level of support; Emphasis on move-on; and Physical setting. The STAX-SA accurately categorized 71.1% (n = 94) of service descriptions, outperforming the comparison tool, and was not affected by publication date or research design. The STAX-SA effectively discriminated between 'real world' service models in England and 53.2% (n = 17) of service managers indicated that the taxonomy was 'Very effective' or 'Extremely effective' in capturing key characteristics of their service. The STAX-SA is an effective tool for classifying supported accommodation models and represents a promising approach to synthesizing the extant effectiveness literature. The authors recommend the development of reporting guidelines for future supported accommodation publications to facilitate comparison between models.

Ineffectiveness of the Tobacco Hazards Prevention Act in patients with severe and persistent mental illness

OBJECTIVES

The effect of the Tobacco Hazards Prevention Act (THPA) on the reduction of tobacco use in the general population in Taiwan is understood. However, there has been little research on how these policies affect people with severe and persistent mental illness (SPMI). Hence, the influence of the THPA on daily cigarette use by patients with SPMI was investigated in a 3-year follow-up. The risk and protective factors in smoking behavior and cessation were investigated.

STUDY DESIGN

This is an observational study.

METHODS

A total of 144 participants (78 of whom had smoked >100 cigarettes throughout their lifetime) were randomly selected from a healthcare network. Then, 100 of 144 patients with SPMI, included 50 smokers and 50 non-smokers, have agreed with 1st year follow-up. Eighty-two patients with SPMI, consisted of 44 smokers and 38 non-smokers, have agreed with 2nd year follow-up.

RESULTS

Although women were less likely to smoke than men, those who did smoke reduced the number of cigarettes less than men over the 3-year period. Less-educated patients were more likely to smoke than those who were more educated but reduced the number of daily cigarettes more after implementation of the THPA. Maternal overprotection was a risk factor and paternal care a protective factor for smoking. Addiction, a perception of pleasure, interpersonal relationships, and self-destructive behavior increased cigarette smoking. Patients perceived that smoking alleviated their depressive symptoms.

CONCLUSIONS

The THPA was ineffective for patients with SPMI. Some factors had different effects on the development of smoking behavior and the cessation process. Understanding the etiology of smoking can help policymakers establish more effective programs for smoking prevention and cessation.

Independent housing and support for people with severe mental illness: systematic review

OBJECTIVE

To systematically explore the outcomes of Independent Housing and Support (IHS) for people with severe mental disorders when compared to other residential settings.

METHOD

Systematic review of Randomised and Non-Randomised Controlled Trials of publications that analyse the outcomes of living in independent settings versus institutionalised accommodation. Risk of bias assessment was adapted from the Cochrane Collaboration's ACROBAT-Tool. The analysis was conducted separately for publications with homeless and non-homeless people.

RESULTS

Twenty-four publications from studies with homeless people and eight publications from studies with non-homeless people were included. Risk of bias was much lower in studies with the homeless. No RCT was found in the sample of publications with the non-homeless. Overall, results from Independent Housing and Support-settings are not inferior to results from institutionalised settings.

CONCLUSION

The results indicate that Independent Housing and Support-settings provide at least similar outcomes than residential care. We propose that clients' preferences should determine the choice of housing setting.

Training in Mental Health Recovery and Social Justice in the Public Sector

Individuals who experience serious mental illness (SMI) frequently encounter stigma and disenfranchisement. Attention to this concern necessitates a social justice focus within the mental health field. This article explores the significance and critical foundations of a psychology training experience grounded in a social justice and recovery-oriented perspective to answer the call for a focus on social justice and empowerment for individuals with SMI in mental health recovery. A specific training program is highlighted as an example of how social justice and recovery-oriented psychology training can be conducted. It includes theoretical foundations, trainee and supervision factors, a training model, and a description of didactic, clinical, consultation, interdisciplinary, and recovery-initiative training experiences. Last, specific successes and challenges of this type of training experience, as well as recommendations for future program development, are shared.

Pattern of disability among persons who availed half-way home-care services for psychosocial rehabilitation

BACKGROUND

There is dearth of studies related to pattern of disability among persons who availed psychosocial rehabilitation services in India. We studied the pattern of disability among persons who availed half-way home-care services for psychosocial rehabilitation.

MATERIALS AND METHODS

Out of 130 case files of discharged patients, 50 files were randomly selected for data collection. Indian Disability Evaluation and Assessment Schedule was used to assess the pattern of disability in the sample.

RESULTS

The study revealed that only one-third (35%) of the residents had disability in self-care, 41% in communication and understanding and 47% in interpersonal relationship. Overall, majority (76%) of the respondents had moderate level of psychiatric disability at the time of discharge from half-way home. There was no significant relationship between gender and type of psychiatric illness with the level of disability. The overall disability correlated positively with the duration of illness (r s=0.39).

CONCLUSION

Three-fourth of the residents who availed half-way home-care services had moderate level of disability.

Factors Related to Family Caregivers’ Satisfaction With Home Care for Mental Illness in Taiwan

In Taiwan, family caregivers play a significant role in the treatment of mentally ill patients at home because of cultural obligations. This descriptive, cross-sectional study explored factors affecting family caregivers’ satisfaction with home care services for the mentally ill and assessed the possibility of continuous use of home care and recommendation of home care to others based on the level of satisfaction of family caregivers. Data were collected using a questionnaire completed by a convenience sample of 75 primary family caregivers of mentally ill patients. Family caregiver satisfaction was significantly associated with caregiver age, marital status, support from family members to assist the caregiver during weekdays and weekends, the amount of time spent in caregiving per week, and feelings about having a mentally ill family member at home. Caregivers who had a higher level of satisfaction with home care were twice as likely as those with lower satisfaction to use the services again when needed. Home care nurses should pay close attention to the variables that support use of home care.

Individual and family adaptation in Taiwanese families of individuals with severe and persistent mental illness (SPMI)

The purpose of this study was to examine individual and family adaptation in Taiwanese families of persons with severe and persistent mental illness. Mediating effects of social support and meaning of family caregiving on the relationship between pile-up of demands and family adaptation were also assessed. Data were collected from 84 families using mailed questionnaires and analyzed using principal component analysis and mixed linear modeling. Adaptation was associated with lower pile-up of demands, greater social support, and more positive interpretation of family caregiving. Partially mediating effects of social support and meaning of family caregiving were supported. The results imply a need for developing culturally sensitive interventions to decrease family demands and amplify individual, family, and community strengths and resources.

Residential program for long-term hospitalized persons with mental illness in Japan: Randomized controlled trial

Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).

Schizophrenia housing and supportive relationships

Schizophrenia can be a very disabling illness that affects between 0.5% and 1% of the population. This illness has a great personal impact on the individual sufferer, their family and friends. In addition, it makes significant demands on health services and the community in general. This paper reviews the literature on housing and supportive relationships for people with schizophrenia. The literature reports that people's experience of their schizophrenia is that it not only causes symptoms, but often impacts on their ability to maintain the basic resources in life. These resources include the ability to maintain reasonable quality housing, which seems to further impact negatively on their illness and their ability to maintain supportive social relationships. People with schizophrenia (and people in general) rely on their social relationships and family to maintain their mental health. The loss of social relationships and inability to maintain quality housing seem to be related - if people cannot maintain quality housing, they find it difficult to maintain supportive social relationships.

Family caregivers' satisfaction with home care for mental illness in Taiwan

In Taiwan, family caregivers play a crucial role in the treatment of patients with mental illness. Attention to family caregivers' satisfaction with home care for mental illness could have a significant impact on the well-being of family caregivers, as well as on the health of the patients with mental illness for whom they care. A descriptive, cross-sectional design has been used to assess the level of family caregivers' satisfaction with home care for mental illness since the implementation of the National Health Insurance (NHI) in Taiwan, and to identify the family caregivers' unmet needs for home care in cases of mental illness. Data were collected using the self-administrated questionnaire completed by a convenience sample of 75 primary family caregivers of the patients with mental illness from a psychiatric hospital in Taipei, Taiwan. The result showed that most family caregivers were highly satisfied with home care provided to them and their relative with mental illness. Timeliness of home care provided in an emergency was the most prevalent unmet need. The implementation of the NHI has improved family caregivers' perceptions of costs of home care services. There is a need to improve NHI policy and home care programmes to provide more holistic services for the patients with mental illness and their family.

Comparison of Quality of Life for People with Schizophrenia and Mental Health of Caregivers Between Community-Based and Hospital-based Services

This study is a comparison of the quality of life and family stress levels in community-based and hospital-based services for people with schizophrenia. Fiscal considerations of the health insurance industry in Taiwan require the evaluation of a community support program versus the traditional, hospital-centered program for reform of mental health policy concerning schizophrenia. The study involved 52 schizophrenic patients, 27 in a community-based program and 25 in a hospital-based treatment model, and was conducted from January to December 2001 in the psychiatric department of a general teaching hospital in southern Taiwan. Outcomes were determined using the World Health Organization quality of life questionnaire (WHOQoL-BREF, Taiwan version), Brief Psychiatric Rating Scale (BPRS), General Health Questionnaire (Chinese version), rate of loss to follow-up, job conditions, and social function. Comparisons of quality of life and caregiver mental health between the two groups were accomplished using descriptive analysis, independent sample t test, and the generalized estimating equation-I. No significant differences between the two groups were found in quality of life or family mental stress according to the General Health Questionnaire after controlling for sex, age, disease duration, full IQ, and total BPRS score. Long disease duration predicted a hospital setting, while a high IQ was predictive of a community setting. We found no decrease in quality of life for schizophrenic patients in a hospital-based program and no increase in family mental stress among the community-based group. To improve patients' quality of life and the mental health of caregivers in both services, it is important to ameliorate severe symptoms associated with schizophrenia.

Placements in psychiatric institutions, nursing homes, and homes for the elderly by Belgian general practitioners

This research is an epidemiological study of long-term care facility admissions to various types of institutions (homes for the elderly, nursing homes, psychiatric institutions) during 1994 in Belgium. Data were obtained from a network of 143 general practitioners, which acts as a reliable surveillance system for health-related data. For every patient who was institutionalized, physicians were asked to record the following information: (1) type of institution in which the patient was placed; (2) medical conditions; (3) current living situation; (4) reason for institutionalization; (5) length of the waiting time for institutionalization, and (6) whether or not the patient was hospitalized prior to the institutionalization. The overall incidence for institutionalization among older patients was 1%. The most common medical conditions upon placement were functional impairments and dementia. Over half the patients lived alone just prior to the placement and family members made the majority of requests for placements. Compared to placements in other types of institutions, those to psychiatric facilities were more likely to be 'urgent' and waiting times for admission to these institutions were shorter. Over half of all placements were preceded by an admission to a medical hospital. Few placements (16%) were made with the consultation of home care services. Finally, in about two thirds of the cases, patients were cared for by their general practitioner while they were institutionalized.