Housing services for people with mental disorders in England: patient characteristics, care provision and costs

Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Social Psychiatry (Impact Factor: 2.54). 04/2009; 44(10):805-14. DOI: 10.1007/s00127-009-0001-0
Source: PubMed


Since de-institutionalisation, housing services have taken a central role in the care of patients with severe mental illness. Yet, little is known about the characteristics of patients in different housing services, what care they receive, and what costs are generated. This study aimed to assess patient characteristics, care provision and costs in different types of housing services in England.
In 12 representative local areas in England, 250 housing services were randomly selected. Information on services, characteristics of randomly selected patients and care received were obtained from managers.
Data from 153 services (61% response rate) and 414 patients were analysed. Most patients receive support with activities of daily living and are involved in some sort of occupational activities. 52% have a care co-ordinator in a community mental health team. Care provision and costs differed significantly between care homes, supported housing services and floating support services.
Quality standards may have to be defined and applied to ensure that all patients in housing services receive appropriate care. More input of mental health services may be required for the rehabilitation and recovery of patients.

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    • "Whether the efforts to maintain these patients in the community are successful or not is crucially related to the nature and availability of accommodation (Moxham & Pegg 2000; Yamada & Korman 2000). Various types of accommodation have been developed, which reflect a continuum of support and staffing levels, from a relatively low level, such as supported group homes, to a high level of support and staff, such as 24-hour staffed facilities (hostels) (Fakhoury et al. 2002; Lamb 1998; Montgomery & Kirkpatrick 2002; Montgomery et al. 2008; O'Malley & Croucher 2005; Priebe et al. 2009; Santone et al. 2005). Similarly, graded stepwise vocational services were developed in the community for the mentally disabled (Cook & Razzano 2000) to enable them to acquire vocational skills and later the ability to work in protective workshops until they are eventually able to get paid employment in the open market (bond 2004; Watzke et al. 2009). "
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    ABSTRACT: In 2001 the Rehabilitation of the Mentally Disabled in the Community Law was implemented in Israel, defining a basket of rehabilitation services to which the mentally disabled are entitled. The objectives of the present study were to examine the effect of being placed in a rehabilitation program after discharge from a psychiatric hospitalization on the probability of rehospitalization and on the length of the following hospitalization if it occurred. Anonymized data were extracted from two registers of the Ministry of Health: the Rehabilitation Register and the Israeli Psychiatric Case Register, whose data were merged. The study population consisted of all the discharges from a psychiatric hospital during 2001-8. There were three study groups (those admitted to hostels, supportive housing, and vocational rehabilitation) and two control groups (those referred to rehabilitation and did not implement the referral and a matched control group of potential candidates for rehabilitation). Kaplan-Meyer survival and Cox analysis were performed on the data. The results showed that the probability to stay in the community after discharge was higher in all the study groups compared to those who were referred but did not reach the rehabilitation system and to the matched control group of potential candidates. Moreover, if the patients were rehospitalized, the probability of a short duration of the next inpatient episode was higher among all the study groups compared to the control groups. The results emphasize the beneficial effect on the pattern of psychiatric hospitalization of the legislation regarding national rehabilitation services for the mentally disabled.
    International Journal of Mental Health 10/2012; 2012 Vol 41( 3)45-59(3). DOI:10.2753/IMH0020-7411410303
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    • "This trend will probably continue in the future. The topic of differential housing services for disabled persons at different levels of functioning has attracted much interest lately [18,19]. "
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    ABSTRACT: In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled. To describe change over time in the characteristics of applicants to rehabilitation committees, types of referral agencies, and the proportion of those referred who were admitted. To identify factors affecting implementation of decisions to admit people with mental disabilities into different rehabilitation services and predictors of the length of time they remain in the services. The study population consisted of all applicants to rehabilitation committees during 2001-2008. Rehabilitation services included hostels, supported housing, and vocational services. Data were extracted from Ministry of Health rehabilitation and psychiatric hospitalization case registers. Findings were analyzed using descriptive statistics, Kaplan-Meier survival analyses, and Cox regressions. There was a trend over time for more patients with shorter or no psychiatric hospitalization histories to be referred to rehabilitation services. Moreover, there was an increase in the proportion of referrals from the community, although the majority of referrals still came from psychiatric hospitals. Less than half of those recommended for a rehabilitation program were admitted and remained in a rehabilitation facility for one year or more. One factor predicting participants' longer stays in rehabilitation services after hospitalization was the proximity of the committees' decisions to the hospitalization. Another factor was the patient receiving vocational services while in residential care. Although over time the new law has resulted in a broader spectrum of people with mental disabilities receiving rehabilitation services, additional efforts are needed to enable them to remain in the system for a sufficient amount of time. Programs addressing specific needs should be developed accordingly.
    Israel Journal of Health Policy Research 06/2012; 1(1):24. DOI:10.1186/2045-4015-1-24
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    • "Prison population rates include pretrial detainees and convicted offenders. The supported housing services include services for chronically mentally ill, for mentally disabled (if separate from physically disabled), for persons with chronic substance use, homes and communities for mentally ill and various forms of protected accommodation schemes [32]. Homes for old people and dementia facilities were not taken into account. "
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    ABSTRACT: General psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context. General psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan, Belarus, Croatia, Czech Republic, East Germany, Hungary, Kazakhstan, Latvia, Poland, Romania, Russia and Slovenia. Percentage change of indicators over the decades 1989-1999, 1999-2009 and the whole period of 1989-2009 and correlations between changes of different indicators were calculated. Between 1989 and 2009, the number of general psychiatric beds was reduced in all countries. The decrease ranged from -11% in Croatia to -51% in East Germany. In 2009, the bed numbers per 100,000 population ranged from 44.7 in Azerbaijan to 134.4 in Latvia. Forensic psychiatric bed numbers and supported housing capacities increased in most countries. From 1989-2009, trends in the prison population ranged from a decrease of -58% in East Germany to an increase of 43% in Belarus and Poland. Trends in different indicators of institutionalised care did not show statistically significant associations. After the political changes in 1989, post-communist countries experienced a substantial reduction in general psychiatric hospital beds, which in some countries may have partly been compensated by an increase in supported housing capacities and more forensic psychiatric beds. Changes in the prison population are inconsistent. The findings do not support the Penrose hypothesis in that historical context as a general rule for most of the countries.
    PLoS ONE 06/2012; 7(6):e38490. DOI:10.1371/journal.pone.0038490 · 3.23 Impact Factor
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