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, Helen Herrman

Journal Name: Current Psychiatry Reviews
Continued as Current Psychiatry Research and Reviews

Volume 7 , Issue 1 , 2011


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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Article Details

Year: 2011
Page: [67 - 83]
Pages: 17
DOI: 10.2174/157340011795945801

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