Long-term outcome of state hospital patients discharged into structured community residential settings

Rl, Okin; Jf, Borus; Baer, Lee; Al, Jones

doi:10.1176/ps.46.1.73

Cited by 38 publications

(35 citation statements)

References 21 publications

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“…Due to the naturalistic nature of the deinstitutionalisation process and the associated research, the majority of the studies were uncontrolled, and often considered a range of community-based accommodation settings within a single study; this contributed, at times, to descriptions of services that lacked detail. Identifiable service types included nursing homes [ 47 , 56 , 65 ], residential care units or high-support hostels with 24 h staffing [ 46 – 48 , 51 , 52 , 54 , 55 , 57 , 59 , 60 , 62 , 63 , 66 ], supported group homes [ 48 , 49 , 55 , 56 , 61 , 64 , 67 ], apartments with flexible support [ 46 , 48 , 56 , 60 ], halfway houses [ 50 , 53 , 58 , 68 , 71 , 73 ], and boarding/rooming houses [ 56 , 59 , 61 ]. Some studies refer to ‘supported housing’ or ‘supported accommodation’ services without providing further detail [ 70 , 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies, including one high quality [ 48 ] and 12 moderate quality studies [ 51 – 53 , 56 , 58 , 60 , 63 , 67 – 69 , 71 , 72 ], examined rates of hospitalisation as an outcome. Unfortunately, the single high quality study did not report data assessing change over time [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Amongst the moderate quality studies, however, supported accommodation appeared to be related to reduce rates of hospitalisation [ 51 , 53 , 60 ] and duration of hospital admissions [ 53 , 69 , 71 ] over time. There was, across almost all studies, clear evidence of high rates of rehospitalisation; a number of moderate quality studies [ 52 , 53 , 56 , 58 , 63 , 67 , 68 , 72 ] indicated between 35 and 87% of participants required inpatient treatment at least once during the follow-up period (range 4–10 years). The single high quality study reported a rehospitalisation rate of 22% during the follow-up period [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…There was strong evidence for improvement or a lack of deterioration in the severity of symptoms of mental illness for patients who were discharged to community-based supported accommodation settings from large institutions. In total, 15 studies examined this outcome, including four high quality [ 46 – 49 ] and 11 moderate quality studies [ 52 , 54 , 56 , 57 , 62 , 63 , 65 , 66 , 70 , 72 , 73 ]. The majority of high quality studies reported improvements in symptoms over time [ 46 , 47 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…Improvement in positive symptoms was most common [ 47 , 50 ]. Findings from the moderate quality papers were less consistent; most reported no change [ 52 , 62 , 63 , 65 , 66 , 70 , 72 , 73 ], or mixed results [ 54 , 56 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

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

McPherson¹,

Krotofil²,

Killaspy³

2018

BMC Psychiatry

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BackgroundPost-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.MethodsUsing 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)’.ResultsResults 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.ConclusionsA 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.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1725-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

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

McPherson¹,

Krotofil²,

Killaspy³

2018

BMC Psychiatry

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The closing of central state hospital: Long-term outcomes for persons with severe mental illness

McGrew

Wright

Pescosolido

et al. 1999

The Journal of Behavioral Health Services & Research

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This study examined the clinical/community functioning of long-stay patients following closing of a large state psychiatric hospital. Two overlapping samples were followed: (1) the tracking project collected information on patient location, treatment provision, legal contacts, and level of functioning (LOF) and followed all discharged patients and (2) the research study subsample, drawn from the final group of discharged patients, gathered information on quality of life (QOL), LOF, and general physical and mental health. At follow-up, patients were functioning equal to or better than prior to discharge. There were consistent improvements in QOL (especially safety and occupational satisfaction) and LOF (especially housing and income/benefits). Fewer than 27% of patients discharged into the community were rehospitalized, and fewer than 4% were either in jail or homeless after 24 months. The study demonstrates that even persons who have been hospitalized for extremely long periods can do well in the community.

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Mental health service use and cost of care for older adults in assisted living facilities: Implications for public policy

Becker

Stiles

Schonfeld

2002

The Journal of Behavioral Health Services & Research

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With changing demographics prompting greater demand for assisted living facility (ALF) care, indigent older adults with mental health needs face underfunded residential care options and mental health systems currently unprepared to meet their service requirements. In particular, over-reliance on inpatient mental health services for older individuals with mental illness and inadequate reimbursement of ALF facilities potentially increase costs and threaten availability of ALF care. This article analyzes Florida's administrative data and presents findings on mental health service use and cost of care for poor older persons. Using Florida as an example, the authors recommend policy changes to ensure the quality and availability of residential care for low-income adults with mental health needs.

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Long-term outcome of state hospital patients discharged into structured community residential settings

Cited by 38 publications

References 21 publications

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

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

The closing of central state hospital: Long-term outcomes for persons with severe mental illness

Mental health service use and cost of care for older adults in assisted living facilities: Implications for public policy

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