Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU)

Abstract

BackgroundAn ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes.MethodsA brief description of the unit’s establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations.ResultsThe initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = −1.15), followed by Social-connection (z-change = −0.82) and Self-belief (z-change = −0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern.ConclusionsThis paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1939-8) contains supplementary material, which is available to authorized users.

Similarities and differences in people accessing prevention and recovery care services and inpatient units in Victoria, Australia

“…NorthWestern Mental Health, Parkville, VIC, Australia. 6 Southern Synergy, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia. 7 Dept of Psychiatry, Monash University, Peninsula Mental Health Service, Frankston, VIC, Australia.…”

“…PARC services, located in the community, offer sub-acute residential care to consumers with serious mental illness who require additional support than would usually be available from community mental health services. They have a strong emphasis on integrating clinical and personal recovery-oriented care, with a commitment to greater consumer involvement and least restrictive practices [1][2][3][4][5][6]. Similar to sub-acute residential services in other states in Australia and in some other high-income countries, PARC services in Victoria play an increasingly important role in the mental health care continuum, supporting consumers to transition from psychiatric inpatient units back into the community (referred to as 'step-down' care) and to prevent or substitute hospitalisation ('step-up' care).…”

“…Studies exploring consumer experiences of the Victorian PARC service model [2] or their equivalents in other states [3][4][5][6] (mostly uncontrolled studies or studies limited by small sample sizes) have provided some information about how these services are operating at the local level. For example, a quasi-experimental study of crisis housing for patients with severe and persistent mental illness in Queensland demonstrated cost savings due to reduced acute psychiatric bed-days.…”

Developing fit-for-purpose funding models for rural settings: Lessons from the evaluation of a step-up/step-down service in regional Australia

“…Sub-acute mental health community services provide a “bridging service,” operating as early intervention from community-based care (step-up) or transition from hospital to the community (step-down) ( 4 ), and have gradually become embedded in the Australian mental health service system ( 5 ). Step Up/Step Down (SUSD) services follow a recovery-oriented model ( 6 ), and are characterized by a shift from clinical recovery to “personal recovery” ( 7 ), described as a uniquely individual process involving gaining new meaning and purpose in life and sometimes a reformation of identity, even in the presence of on-going symptoms ( 8 ).…”

“…Despite its complexity, there is a growing body of literature that demonstrates the clinical and cost-effectiveness of the SUSD model ( 1 ). The evaluation of the growing SUSD sector in Australia has shown positive outcomes regarding quality of life, symptoms and functioning ( 4 , 7 , 13 – 15 ), progress toward achieving goals identified on the individual recovery plans ( 16 ), and consumer satisfaction with service delivery, relating to elements such as service approach and ethos, program activities, safety, and communal qualities and environment ( 7 , 14 , 17 , 18 ). Although more limited, there is also some encouraging evidence of the positive short-term impact on quality of life after discharge ( 15 ).…”