scholarly journals A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services

2022 ◽  
pp. 1-5
Author(s):  
Thomas Rhys Edwards ◽  
Alan Meaden ◽  
Martin Commander
Keyword(s):  
Systems Approach ◽  
Psychiatric Rehabilitation ◽  
Service Evaluation ◽  
Rehabilitation Services ◽  
Treatment Pathway ◽  
Time Period ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation ◽  
Whole Systems

Aims and method This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Results Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. Clinical implications New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

The psychology quadrant: an outcome measure based on the START risk assessment

2017 ◽  
Vol 19 (1) ◽  
pp. 14-22
Author(s):  
Matthew John Gill ◽  
Samantha Brookes
Keyword(s):  
Risk Assessment ◽  
Factor Structure ◽  
Psychiatric Rehabilitation ◽  
Principal Component ◽  
Future Research ◽  
Psychological Outcome ◽  
Content Type ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation ◽  
Outcome Tool

Purpose The purpose of this paper is to develop a psychological outcome tool which reflects the relationship between clusters of items on the Short Term Assessment of Risk and Treatability (START) risk assessment and different categories of psychological progress in male inpatient psychiatric services. Design/methodology/approach A principal component analysis (PCA) was conducted on data from 135 male psychiatric rehabilitation patients’ START risk assessments. Findings PCA identified four strength psychology quadrants which were explained by a five-factor structure and four vulnerability quadrants which were explained by a four-factor structure. The development of the psychology quadrant, its usefulness in establishing a treatment pathway and areas of future research are also discussed. Originality/value Developing accessible, transparent outcome measures using evidence-based practice is highly relevant within the field of mental health rehabilitation.

scholarly journals Scottish rehabilitation services: eight year follow-up

1993 ◽  
Vol 17 (6) ◽  
pp. 341-344
Author(s):  
Robin G. McCreadie ◽  
Douglas J. Williamson ◽  
Lesley J. Robertson
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Mentally Ill ◽  
Support Services ◽  
Psychiatric Rehabilitation ◽  
Rehabilitation Services ◽  
Local Authorities

A survey of Scottish psychiatric rehabilitation and support services, carried out in 1983 (McCreadie et al, 1985), found that although there were wide between-hospital differences, the National Health Service in Scotland was making considerable efforts to provide services for the long-term mentally ill. However, services provided by local authorities were seriously deficient.

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).

Developing specific involvement strategies within a psychologically informed planned environment: a service evaluation

2019 ◽  
Vol 14 (4) ◽  
pp. 264-276
Author(s):  
Karine Greenacre ◽  
Rebecca Paez
Keyword(s):  
Design Methodology ◽  
Systems Approach ◽  
User Involvement ◽  
Service Evaluation ◽  
Political Factors ◽  
Content Type ◽  
Forensic Practice ◽  
Whole Systems ◽  
Current Systems ◽  
Review Current

PurposeThe purpose of this paper is to apply current understanding of service user involvement (SUI) to forensic practice with reference to the benefits and drawbacks. Specifically, it discusses models of SUI and their application to a psychologically informed planned environment (PIPE) located in a Category C male prison.Design/methodology/approachDrawing upon residents’ experiences, the evaluation reflects on the contribution of cultural, environmental and political factors to the success or failure of SUI within the PIPE service.FindingsThe evaluation will review current systems and explore ways of improving and strengthening strategies by referring to the “whole systems approach” to SUI (Wright, 2006).Originality/valueThe evaluation makes recommendations for local and national SUI within PIPE services.

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 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.

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