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.

Quality assessment of mental health rehabilitation services

2016 ◽  
Vol 33 (S1) ◽  
pp. S6-S6
Author(s):  
H. Killaspy
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Quality Assessment ◽  
Assessment Tool ◽  
Health Care Facilities ◽  
Rehabilitation Services ◽  
Inpatient Mental Health ◽  
Health Rehabilitation ◽  
Mental Health Rehabilitation

ObjectivesProviding good quality mental health care is vital to achieve better outcomes but service quality is a complex, multidimensional construct that extends beyond the delivery of specific evidence based treatments and interventions. This makes it difficult to operationalize and measure, particularly at the international level where different socioeconomic and political contexts impact. Mental health rehabilitation services focus on people with severe and complex psychosis. This group are one of the most socially excluded in society and are vulnerable to exploitation and abuse. They are also, be definition, difficult to treat and, historically, have often been institutionalised in hospital or community facilities.AimsThis presentation will report on the development and application of an internationally validated quality assessment tool for longer term mental health care facilities, the Quality Indicator for Rehabilitative Care (QuIRC).MethodsThe content of the QuIRC was derived from a systematic literature review, international Delphi exercise and review of care standards in ten European countries. Its psychometric properties were assessed in over 200 longer-term mental health facilities across Europe involving validation with over 1750 service users. It has subsequently been used in a national programme of research into inpatient mental health rehabilitation services in England which will also be briefly described.ResultsThe QuIRC has excellent inter-rater reliability and validity. Specific aspects of care assessed by the QuIRC have been found to be associated with successful community discharge from inpatient mental health rehabilitation services.ConclusionsThe QuIRC is a free to use, standardised and validated on-line international quality assessment benchmarking and research tool, available in ten European languages.Disclosure of interestThe author has not supplied his declaration of competing interest.

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.

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

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.

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