Community and hospital residential care: a comparative evaluation

Abstract

Objective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.

Our lives in three parts: an autoethnographic account of two undergraduates and their respective psychiatric careers

“…Perkins and Dilks (1992) commented on how symptom and identity problems made it very hard for mental health professionals to establish working relationships with service users. Quality of life research conducted by Jerome and colleagues showed an additional "gulf" between people who provided mental health services and those who used them (Carson et al, 1997;Missenden et al, 1996). More recently Rosie Allen and colleagues have shown significant differences in flourishing between people with mental health problems and community groups (Allen et al, 2020).…”

Still worlds apart: flourishing in people with mental health problems

“…It always struck the second author that there were more differences than just symptoms and identity between professionals and service users, and that in many ways each group inhabited different worlds. Comparisons between staff and service users also showed that quality of life was markedly different between the two groups (Carson et al, 1997;Missenden et al, 1996). Towards the end of the 20th century, recovery became the dominant model in mental health services and many professionals starting working in partnership with service users, inspired by individuals like Bill Anthony, Geoff Shepherd, Patricia Deegan, Mike Slade, Peter Bullimore and Rachel Perkins, to name but a few pioneers.…”