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Current Psychiatry Reviews

Editor-in-Chief

ISSN (Print): 1573-4005
ISSN (Online): 1875-6441

Continuing Accommodation and Support Needs of Long-Term Patients with Severe Mental Illness in the Era of Community Care

Author(s): Prem Chopra, Carol Harvey and Helen Herrman

Volume 7 , Issue 1 , 2011

Page: [67 - 83] Pages: 17

DOI: 10.2174/157340011795945801

Price: $65

Abstract

Background: The accommodation and support needs of former long-stay and “new” long-stay patients with severe mental illness are complex. These two groups with different histories but similar needs are referred to in this paper as long-term patients. The science of psychiatric rehabilitation has advanced, but residential instability, homelessness, forensic involvement and substance abuse contribute to the rehabilitation challenges for long-term patients.

Methods: This paper reviews recent evidence concerning outcomes of community mental health care for long-term patients. It reviews models of residential rehabilitation and residential care and the application of recovery principles to them.

Results: Long-term patients continue to experience unstable accommodation, isolation, poor quality of life and are vulnerable to reinstitutionalisation. Their varied needs can be met effectively, but are frequently not met in a sustained way. Positive outcomes are associated with provision of choices in small-scale accommodation services that are linked with assertive outreach from specialist mental health teams and integrated with existing community services.

Conclusions: Providing the accommodation and care needed by long-term patients to support recovery and effective rehabilitation requires analysis of the determinants of outcomes for patients in residential and non-residential settings. Particular attention is needed to continuing enhanced community mental health care, treatment of concurrent substance use and access to a range of residential support services for as long as necessary. For a small but important minority of patients there is a need to continue these arrangements indefinitely. Research on the essential ingredients of effective models of care, including consumer perspectives, is required.

Keywords: Residential rehabilitation, deinstitutionalisation, community mental health care, residential care, long-stay patients, severe mental illness, meta-analysis, community


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