Reducing hospitalisation among people living with severe mental illness

Abstract

Objective People with severe mental illness have high rates of hospitalisation. The present study examined the role that permanent housing and recovery-oriented support can play in reducing the number and length of psychiatric hospital admissions for people with severe mental illness. Methods The study examined de-identified, individual-level health records of 197 people involved in the New South Wales Mental Health Housing and Accommodation Support Initiative (HASI) to compare changes in hospitalisation over a continuous 4-year period. Results On average, HASI consumers experienced significant reductions in the number of psychiatric hospital admissions and length of stay after entering the HASI program, and these reductions were sustained over the first 2 years in HASI. Male consumers and consumers under 45 years of age experienced the largest reductions in the number and length of hospital admissions. Conclusions The findings of the present study add support to the hypothesis that supported housing and recovery-oriented support can be effective approaches to reducing hospital admissions for people with chronic mental illness, and that these changes can be sustained over time. What is known about this topic? People living with severe mental illness are heavy users of health and hospitalisation services. Research into the effects of partnership programs on preventing unnecessary admissions is limited because of short periods of comparison and small sample sizes. What does this paper add? The present study extends previous research by analysing de-identified individual-level health records over a continuous 4-year period and showing that reductions in hospitalisation among people with severe mental illness can be sustained over time. What are the implications for practitioners? These findings provide further evidence that community-based recovery-oriented supported housing programs can assist consumers to manage their mental health and avoid hospital admissions. Although the provision of recovery-oriented community services requires an investment in community mental health, the reduction in consumers' use of hospital services makes this investment worthwhile.

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

“…For this group of papers, service types ranged from intensive congregate residential care settings, with 24 h staffing [ 76 , 78 – 80 , 87 , 89 , 93 , 95 ], to less intensively supported accommodation, including group homes and supervised individual apartments (e.g. staffed 9 am-5 pm daily) [ 74 , 78 , 81 , 82 , 90 , 92 – 94 ], to individual tenancies with outreach support (staff based off-site) [ 75 , 81 , 83 , 87 , 88 , 90 , 96 ]. Other service descriptions lacked detail and were unable to be confidently categorised, including “sheltered housing” [ 77 ], “sheltered-care facilities” [ 86 ], “community-based housing” [ 91 ], “transitional, high-expectation, sheltered care environment” [ 85 ] and “support house” [ 84 ].…”

“…Twelve papers, including two high quality [ 92 , 94 ] and ten moderate quality studies [ 74 , 77 , 78 , 81 , 82 , 84 , 88 – 90 , 96 ], reported data relating to changes in rates of hospitalisation. The findings were mixed.…”

“…The findings were mixed. Generally, it appeared that supported accommodation was associated with a reduction in days spent in hospital [ 78 , 81 , 82 , 89 , 90 ], and duration of hospital stays [ 96 ], over time. One study demonstrated a significant reduction in mean number of hospital and crisis centre admissions from pre-entry into a residential program to one-year post-discharge [ 89 ].…”

What Works? Toward a New Classification System for Mental Health Supported Accommodation Services: The Simple Taxonomy for Supported Accommodation (STAX-SA)

“…Non-English language papers were excluded to ensure faithful application of the taxonomies. The final pool consisted of 132 service descriptions across 101 papers (quantitative: 95 service descriptions across 72 papers; qualitative: 37 service descriptions across 29 papers) [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,…”

“It's hard work, believe me!”: Active efforts to optimise housing by people who live with mental illness and access housing assistance

“…This “housing first” initiative acknowledges and has demonstrated the importance of stable housing to mental health outcomes (Bullen & Fisher ; McDermott et al. ). It also speaks to the indistinctness of the line between housing support and other types of support, as general supports for mental health and social inclusion are also critical for maintenance of accommodation (O'Brien et al.…”