Assessing the quality of mental health rehabilitation services

2015 ◽  
Vol 12 (03) ◽  
pp. 167-173
Author(s):  
H. Killaspy
Keyword(s):  
Mental Health ◽  
Inpatient Rehabilitation ◽  
Community Services ◽  
Term Treatment ◽  
Rehabilitation Services ◽  
Built Environments ◽  
Recovery Orientation ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

Summary Background: Mental health rehabilitation services focus on people with severe and complex problems that impair their function and make them potentially vulnerable to exploitation and abuse. They require longer term treatment and support from a range of inpatient and community services that hold therapeutic optimism and adopt a recovery orientation. Aims: In recent years, specific tools and processes have been developed to facilitate assessment of the quality of care in services that provide rehabilitation. These include the built environments where people receive support, the therapeutic culture of these facilities, the treatments and interventions provided, the degree to which autonomy and community engagement are promoted, and the process for safeguarding human rights. Results: When local rehabilitation services are available, most people are able to be successfully discharged to the community, achieving greater independence incrementally. The quality of inpatient rehabilitation services has been shown to be positively associated with service users’ autonomy, the main aim of rehabilitation, with the most important aspect being the recovery orientation of the service.

scholarly journals The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

2017 ◽  
Vol 5 (7) ◽  
pp. 1-284 ◽  
Author(s):  
Helen Killaspy ◽  
Michael King ◽  
Frank Holloway ◽  
Thomas J Craig ◽  
Sarah Cook ◽  
...  
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
National Survey ◽  
Assessment Tool ◽  
Rehabilitation Services ◽  
Service Users ◽  
Inpatient Mental Health ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

scholarly journals Service quality and clinical outcomes: an example from mental health rehabilitation services in England

2013 ◽  
Vol 202 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Helen Killaspy ◽  
Louise Marston ◽  
Rumana Z. Omar ◽  
Nicholas Green ◽  
Isobel Harrison ◽  
...  
Keyword(s):  
Mental Health ◽  
Service Quality ◽  
Clinical Outcomes ◽  
Rehabilitation Services ◽  
Service Users ◽  
User Characteristics ◽  
Therapeutic Milieu ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

BackgroundCurrent health policy assumes better quality services lead to better outcomes.AimsTo investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes.MethodStandardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes.ResultsA total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life.ConclusionsQuality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

Mental health rehabilitation services in Ireland: vision and reality

2011 ◽  
Vol 28 (2) ◽  
pp. 69-75
Author(s):  
Atif Ijaz ◽  
Helen Killaspy ◽  
Frank Holloway ◽  
Fiona Keogh ◽  
Ena Lavelle
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
National Survey ◽  
Service Provision ◽  
Rehabilitation Services ◽  
Assertive Outreach ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation ◽  
Specialist Rehabilitation

AbstractObjectives: The Irish national mental health policy document, A Vision for Change, included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision.Method: A structured questionnaire was sent to consultant rehabilitation psychiatrists in all mental health catchment areas of Ireland that had any rehabilitation services to gather data on various aspects of service provision.Results: Twenty-six of the 31 mental health areas of Ireland had some form of rehabilitation service. Sixteen teams working in 15 of these areas fulfilled A Vision for Change criteria to be defined as specialist rehabilitation services and all 16 responded to the survey. The overall response rate was 73% (19/26). Most services lacked a full multidisciplinary team. Only one service had an assertive outreach team with acceptable fidelity to the assertive outreach model. Urban services were less well resourced than rural services.Conclusion: This is the first national survey to describe the provision of mental health rehabilitation services in Ireland. Although there has been an increase in the provision of consultant-led specialist rehabilitation services nationally, these services lack multidisciplinary input. There also appears to be a lack of planned provision of the facilities required to provide comprehensive rehabilitation services with unequal distribution of resources between urban and rural areas. This has potential cost implications for local mental health services in relation to ‘out of area treatment’ placements and perhaps more importantly to the overall quality of patient care.

scholarly journals The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis

2021 ◽  
Vol 11 ◽  
Author(s):  
Christian Dalton-Locke ◽  
Louise Marston ◽  
Peter McPherson ◽  
Helen Killaspy
Keyword(s):  
Mental Health ◽  
Service Use ◽  
Mental Health Problems ◽  
Homeless People ◽  
Rehabilitation Services ◽  
Inpatient Service ◽  
Supported Accommodation ◽  
Community Rehabilitation ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

Introduction: Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services.Methods: We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out.Results: We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services (n = 34); services for homeless people with severe mental health problems (n = 13); deinstitutionalization programmes (n = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes.Conclusions: Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required.Review registration: This review was prospectively registered on PROSPERO (ID: CRD42019133579).

scholarly journals Consumers' understanding and expectations of a community-based recovery-oriented mental health rehabilitation unit: a pragmatic grounded theory analysis

2017 ◽  
Vol 28 (04) ◽  
pp. 408-417 ◽  
Author(s):  
Stephen Parker ◽  
Frances Dark ◽  
Ellie Newman ◽  
Dominic Hanley ◽  
William McKinlay ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Rehabilitation Services ◽  
Structured Interviews ◽  
Community Based ◽  
Rehabilitation Unit ◽  
Staffing Model ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

Aims.Incorporating consumer perspectives into mental health services design is important in working to deliver recovery-oriented care. One of the challenges faced in mental health rehabilitation services is limited consumer engagement with the available support. Listening to consumers’ expectations of mental health services, and what they hope to achieve, provides an opportunity to examine the alignment between existing services and the priorities and preferences of the people who use them. We explored consumer understandings and expectations of three recovery-oriented community-based residential mental-health rehabilitation units using semi-structured interviews; two of these units were trialling a staffing model integrating peer support with clinical care.Methods.Twenty-four consumers completed semi-structured interviews with an independent interviewer during the first 6 weeks of their stay at the rehabilitation unit. Most participants had a primary diagnosis of schizophrenia or a related psychotic disorder (87%). A pragmatic approach to grounded theory guided the analysis, facilitating identification of content and themes, and the development of an overarching conceptual map.Results.The rehabilitation units were considered to provide a transformational space and a transitional place. The most common reason given for engagement was housing insecurity or homelessness rather than the opportunity for rehabilitation engagement. Differences in expectations did not emerge between consumers entering the clinical and integrated staffing model sites.Conclusions.Consumers understand the function of the rehabilitation service they are entering. However, receiving rehabilitation support may not be the key driver of their attendance. This finding has implications for promoting consumer engagement with rehabilitation services. The absence of differences between the integrated and clinical staffing models may reflect the novelty of the rehabilitation context. The study highlights the need for staff to find better ways to increase consumer awareness of the potential relevance of evidence-based rehabilitation support to facilitating their recovery.

The Effect of Community-Based Mental Health Rehabilitation Services for Schizophrenia: a Retrospective Cohort Study

2020 ◽  
Vol 91 (4) ◽  
pp. 1453-1463
Author(s):  
Israel Krieger ◽  
Dana Tzur Bitan ◽  
Rachel Sharon-Garty ◽  
Vered Baloush-Kleinman ◽  
Leora Zamir
Keyword(s):  
Mental Health ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rehabilitation Services ◽  
Community Based ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

scholarly journals Mental health rehabilitation services in the UK in 2007

2009 ◽  
Vol 33 (6) ◽  
pp. 215-218 ◽  
Author(s):  
Debbie Mountain ◽  
Helen Killaspy ◽  
Frank Holloway
Keyword(s):  
Service Provision ◽  
Rapid Change ◽  
Community Services ◽  
Rehabilitation Services ◽  
Clinical Implications ◽  
Complex Needs ◽  
The Past ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation ◽  
The Uk

Aims and MethodA survey of UK consultants in rehabilitation psychiatry was carried out to investigate current service provision and changes over the past 3 years.ResultsMost services had undergone multiple changes, with an overall reduction in over half and an overall expansion in a minority. the proportion with low secure provision had doubled. Around a third reported reinvestment of rehabilitation resources into other specialist in-patient and community services.Clinical ImplicationsRehabilitation services are undergoing rapid change with diversion of resources into services that may lack rehabilitation expertise. This risks an increase in independent sector referrals for in-patient rehabilitation for those with complex needs. Expansion of community services should be balanced against the need for local in-patient rehabilitation services.

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