The Impact of Realigning a Tertiary Psychiatric Hospital in British Columbia on Other Institutional Sectors
Forensic Psychiatric Services Commission, 70 Colony Farm Rd., Port Coquitlam, British Columbia V3C 5X9, Canada. Psychiatric services (Washington, D.C.)
(Impact Factor: 2.41).
02/2011; 62(2):200-5. DOI: 10.1176/appi.ps.62.2.200
Deinstitutionalization is an ongoing process, as many jurisdictions continue to struggle with redesigning their psychiatric systems. Historically, reducing psychiatric beds and closing hospitals have resulted in deleterious outcomes for people with severe and persistent mental illness. More recent evidence suggests that careful implementation of deinstitutionalization policies can thwart potential adverse consequences and may even foster favorable outcomes. This study evaluated the extent to which the recent devolution of the only tertiary psychiatric hospital in British Columbia resulted in a direct shift of individuals to other institutional sectors, such as criminal justice and health sectors.
Admission rates to general hospitals, continuing care facilities, correctional institutions, and forensic psychiatric facilities were compared among two patient groups: those discharged before the realignment of the tertiary psychiatric hospital system (prerealignment cohort) (N=164) and those discharged after initiation of the system reforms (postrealignment cohort) (N=171).
Most of the patients in the postrealignment cohort have remained in the tertiary care settings to which they were originally discharged. For patients in the postrealignment cohort, contact with other institutional sectors was rare and shorter in duration than it was for patients in the prerealignment cohort.
This study provides preliminary evidence that recent efforts to realign British Columbia's provincial tertiary psychiatric hospital system have not resulted in a significant shift of the relocated patients to institutions in other sectors.
Available from: Emmanuel Stip
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ABSTRACT: The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia.
This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members.
There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.
This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness.
Available from: Stefanie N Rezansoff
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ABSTRACT: Objectives Little research has investigated the role of migration as a potential contributor to the spatial concentration of homeless people with complex health and social needs. In addition, little is known concerning the relationship between possible migration and changes in levels of service use over time. We hypothesised that homeless, mentally ill individuals living in a concentrated urban setting had migrated from elsewhere over a 10-year period, in association with significant increases in the use of public services.
Setting Recruitment was concentrated in the Downtown Eastside neighbourhood of Vancouver, Canada.
Participants Participants (n=433) met criteria for chronic homelessness and serious mental illness, and provided consent to access administrative data.
Methods Linked administrative data were used to retrospectively examine geographic relocation as well as rates of health, justice, and social welfare service utilisation in each of the 10 years prior to recruitment. Generalised estimating equations were used to estimate the effect of migration on service use.
Results Over a 10-year period there was significant movement into Vancouver's Downtown Eastside neighbourhood (from 17% to 52% of the cohort). During the same period, there were significant annual increases in community medical services (adjusted rate ratio (ARR) per year=1.08; 95% CI 1.06 to 1.10), hospital admissions (ARR=1.08; 95% CI 1.04 to 1.11), criminal convictions (ARR=1.08; 95% CI 1.03 to 1.13), and financial assistance payments (ARR=1.04; 95% CI 1.03 to 1.06). Migration was significantly associated with financial assistance, but not with other types of services.
Conclusions Significant increases in service use over a 10-year period coincided with significant migration into an urban area where relevant services were concentrated. These results highlight opportunities for early intervention in spatially diverse neighbourhoods to interrupt trajectories marked by worsening health and extremely high service involvement. Further research is urgently needed to investigate the causal relationships between physical migration, health and social welfare, and escalating use of public services.
Trial registration numbers ISRCTN57595077 and ISRCTN66721740; Post-results.
Available from: Julian M Somers
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