Community-care unit model of residential mental health rehabilitation services in Queensland, Australia: predicting outcomes of consumers 1-year post discharge

Abstract

Aims Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. Methods Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. Results Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (β = 1.12) and longer episodes of CCU care (β = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. Conclusions CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.

Comparative Effectiveness of Integrated Peer Support and Clinical Staffing Models for Community-Based Residential Mental Health Rehabilitation: A Prospective Observational Study

“…The gains in clinical and functional outcomes are consistent with the literature supporting the positive impact of mental health rehabilitation (Chan et al, 2021;Dalton-Locke et al, 2020). Unlike a recent retrospective cohort study that included only clinical staffing model sites (Parker et al, 2020), reliable improvements in disability occurred for most consumers. However, our study focused on admissiondischarge outcomes rather than pre-admission and post-discharge.…”

“…Most people accessing these services are diagnosed with schizophrenia and have complex care needs (Dalton-Locke et al, 2020;Parker et al, 2019aParker et al, , 2019bParker et al, , 2019c. Providing intensive support over an extended duration in a residential setting incurs high costs per episode of care (Parker et al, 2020). Despite the costs associated with these services, there have been limited comparative studies to establish their effectiveness (Dalton-Locke et al, 2020;Parker et al, 2019aParker et al, , 2019bParker et al, , 2019c, and TRR service capacity has expanded considerably in Australia over the last decade (Karan et al, 2022).…”

The state of psychiatric research in the Asia Pacific region

“…Specific and vulnerable populations, such as the rurally located, children and adolescents, perinatal, geriatric, and early psychosis, are especially affected (Dhandapani et al, 2020; Ransing, Kukreti, et al, 2020; Verma, Grover, Singh, Dahiya, & Nehra, 2020). Examples of initiatives to tackle these issues include Project BIND‐P, a perinatal mental health project (Ransing, Deshpande, et al, 2020), a healthcare worker‐based collaborative model for the National Mental Health program, as well as various community mental health programs and mHGAP specific initiatives (Ahuja et al, 2020; Pandya, Shah, Chauhan, & Saha, 2020; Parker et al, 2020).…”

Community-based psychosocial rehabilitation model for people with schizophrenia

“…A study in Australia was conducted with different methods for community-based psychosocial therapy with a community care unit model of psychiatric rehabilitation. The model was a psychiatric rehabilitation model that aimed to improve the independence and community functioning of people with severe and persistent mental illness (Parker et al, 2020). This study used data from a retrospective cohort (n = 501) of all patients admitted to five Community Care Units (CCU) in Queensland, Australia, between 2005 and 2014, proving a significant predictor of improvement in mental health and social functioning due to longer duration of stay.…”

“…DOI: http://dx.doi.org/10. 30651/jqm.v6i2.13116 This is an Open acces article under the CC-BY license aspects of personal functioning -particularly the development of life skills and community integration -within the context of overall mental health, and providing rehabilitation support 24 hours to people with serious mental illness (Meehan et al, 2017;Parker and Siskind, 2019) . At the individual level, CCU treatment followed by RCS demonstrated improved mental and functional health in 43% of patients.…”