Factors predicting discharge of patients from community residential facilities: a longitudinal study from Italy.
ABSTRACT Community residential facilities for psychiatric patients have increased in Italy in the last years, but little information is available on their use, the patients they host, the interventions they deliver and the rate at which they discharge patients. To investigate these issues, we conducted a longitudinal study in 2000-2001 on all the community residential facilities in Lombardy, a large region in North Italy.
The study base comprised all the patients residing in the community residential facilities identified in Lombardy in 2000. Out of the 196 community residential facilities identified, 91% agreed to participate. The study sample consisted of all the patients living in the residential facilities on 15 November, 2000. A total of 1792 patients were recruited and described.
In the study period, a total of 316 patients were discharged. Among these, 191 (11%) went to lower-protection settings or home and 49 (3%) to higher-protection settings. The probability of discharge to lower-protection settings and home was higher for people in residential care centres, not coming from a psychiatric hospital, having shorter duration of the current admission, having work at the time of admission and with a low HoNOS score. Associations were found between discharge to higher-protection settings and old age, inadequate accommodation in staff opinion, and the public sector managing the facility.
Turn-over of patients in the community residential facilities was limited. Discharges to higher-protection settings were related to need for specific care for older patients. Type of facility and duration of stay predicted discharge to lower-protection facilities and home independently from other patient characteristics. If a higher turn-over and a more extensive use of this resource must be achieved, roles of other psychiatric and social community-based services should be taken into account.
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ABSTRACT: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100,000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of community care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.Australian and New Zealand Journal of Psychiatry 11/1998; 32(5):673-9. · 3.29 Impact Factor
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ABSTRACT: This paper describes pathways followed by 567 long-stay patients who were resettled into the community, as part of a program to close two psychiatric hospitals in London and replace them with community-based services. Sixty-one percent of the former patients remained in their original placement--mostly group homes--over the five-year follow-up. Transition from one house to another mostly took a direct course, with only 27 patients changing houses by way of long intermediate hospitalisation. Change of residence was at the same level of support, with only a slight trend towards less supervised facilities. Ten patients could not be traced and have possibly become homeless. Only 3 patients were in prison during the five-year follow-up. More than a third of the sample were readmitted at least once during that period. It is concluded that community residences established under the resettlement program served as relatively stable homes for the majority of patients.Community Mental Health Journal 09/1998; 34(4):407-17. · 1.03 Impact Factor
- The British Journal of Psychiatry 05/1999; 174:432-4. · 6.61 Impact Factor