Outcome of community-based rehabilitation program for people with mental illness who are considered difficult to treat

Abstract

Abstract-This observational study investigated the outcomes of a community-based rehabilitation program that was designed to enhance social functioning, social inclusion, and well-being of people with mental illness who were considered treatment failures by psychiatric professionals in Italy. Of the 144 patients who entered the program, 131 started the program and 109 completed either 12 or 18 months of treatment. Illness severity was assessed by the Health of the Nation Outcome Scales (HoNOS) and social functioning by the Social and Occupational Functioning Assessment Scale (SOFAS). On the HoNOS, 33% of patients showed reliable change. On the SOFAS, 27% showed reliable change, although the change was substantial for few patients. Over time, patients showed moderate but significant improvements on the HoNOS and SOFAS. The HoNOS subscales concerning interpersonal relationships and social inclusion showed significant change. Very isolated people with mental illness gained some advantages from this rehabilitation program that was based on a close relationship with a key worker; however, the program duration may have been inadequate to produce substantial changes. Our findings warrant further research based on controlled studies.

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

“…The mean HoNOS score of consumers in the current study decreased by 4.9 points (from 18.4). This improvement is close to that observed by Macpherson et al (2017), exceeds that reported by Barbato et al (2007), but was less than that observed in samples of rehabilitation patients with lower baseline severity (Gonda et al, 2012;Maxwell et al, 2018). Different follow-up periods may be a factor affecting the magnitude of improvement observed across studies (Lim et al, 2017).…”

Effect of the Connecting People Intervention on Social Capital: A Pilot Study

“…However, it was anticipated that improved social connectedness and inclusion would have a positive impact on mental well-being, but this may take longer than the nine-month study period to become evident. This is consistent with findings from a community-based rehabilitation program in Italy which found that most change in social functioning, perceived inclusion and mental wellbeing occurred within first six months followed by a plateau in next six months and then a smaller improvement in final six months (Barbato et al, 2007). Future evaluations of the CPI would benefit from 12-18 month follow-up to test the changes to mental wellbeing over time.…”

A review of social participation interventions for people with mental health problems

“…They undertook social or leisure activities for about 2 h a week over a 9-month periodAdults with schizophrenia, schizo-affective disorder, depression or bipolar disorderRandomised controlled trial [49]Both intervention and control groups (who also received a €20 monthly stipend) increased in recreational social functioning and decreased in social loneliness Urban project The project aimed to enhance participants’ social functioning, general well-being and social inclusion through participation in community life, particularly leisure and recreation facilities. Specific issues such as self-care, psychological well-being, family relationships and interpersonal skills were addressed as intermediate goalsAdults with severe mental health problems who did not engage well with mental health servicesSingle-group pre-post study [50]Improvements were observed in interpersonal skills, links with social networks and participation in the community Independence through Community Access and Navigation (I-CAN) A recreational therapy to support community-based participation, matching individuals with interest-based activities and supported participationAdults with schizophreniaQualitative pilot study [23]Participants reported increased community involvement Social network intervention Staff identified possible areas of interest for individuals and proposed social activities taking place with members of the community outside mental health servicesAdults with schizophreniaRandomised controlled trial [52]A social network improvement was observed in 40% participants in the intervention group in comparison with 25% in the control group at 1-year follow-up. Improvements persisted at 2-year follow-up Connecting People Intervention Staff work with mental health service users to identify opportunities within their local community to achieve their recovery-oriented goals.…”

“…In contrast, a project in Italy involving a team of professionals working flexibly to meet the needs of people who were difficult to engage with mental health services appeared more successful at engaging them in community leisure and recreation facilities [50]. This was associated with significant improvements in social functioning.…”