Advertisement

Community Mental Health Journal

, Volume 47, Issue 5, pp 531–541 | Cite as

The Long-term Outcomes and Unmet Needs of a Cohort of Former Long-Stay Patients in Melbourne, Australia

  • Prem Chopra
  • Helen E. Herrman
Original Paper

Abstract

Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent’s Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients.

Keywords

Deinstitutionalisation Long-Stay patients Psychiatric rehabilitation 

References

  1. Abrahamson, D. (1993). Institutionalisation and the long-term course of schizophrenia. British Journal of Psychiatry, 162, 533–538.PubMedCrossRefGoogle Scholar
  2. Anthony, W. (2000). A recovery-oriented service system: Setting some system level standards. Psychiatric Rehabilitation Journal, 24(2), 159–168.Google Scholar
  3. Anthony, W. A., & Liberman, R. P. (1986). The practice of psychiatric rehabilitation: Conceptual and research base. Schizophrenia Bulletin, 12, 542–559.PubMedGoogle Scholar
  4. Australian Health Ministers. (1998). Second National mental health plan. Canberra: Commonwealth Department of Health and Community Services.Google Scholar
  5. Australian Mental Health Outcomes and Classification Network. (2005). Adult National Outcomes & Casemix. Collection standard reports version 1.1 (1st ed.). Brisbane, QLD.Google Scholar
  6. Bennett, D. H. (1980). The chronic psychiatric patient today. Journal of the Royal Society of Medicine, 73, 301–303.PubMedGoogle Scholar
  7. Eagar, K., Trauer, T., & Mellsop, G. (2005). Performance of routine outcome measures in adult mental health care. Australian and New Zealand Journal of Psychiatry, 39, 713–718.PubMedCrossRefGoogle Scholar
  8. Fossey, E., Epstein, M., Findlay, R., & Harvey, C. (2002a). Creating a positive experience of research for people with psychiatric disabilities by sharing feedback. Psychiatric Rehabilitation Journal, 25, 369–378.PubMedGoogle Scholar
  9. Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002b). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry, 36, 717–732.PubMedCrossRefGoogle Scholar
  10. Harding, C. M. (1988). Course types in schizophrenia: An analysis of European and American studies. Schizophrenia Bulletin, 14, 633–643.PubMedGoogle Scholar
  11. Harrison, G., Hopper, K., Craig, T., Laska, E., Siegel, C., Wanderling, J., et al. (2001). Recovery from psychotic illness: A 15- and 25-year international follow-up study. British Journal of Psychiatry, 178, 506–517.PubMedCrossRefGoogle Scholar
  12. Harvey, C. A. (1996). The camden surveys I: The psychiatric, behavioural and social characteristics of the severelyl mentally ill in an inner London health district. British Journal of Psychiatry, 168, 410–417.PubMedCrossRefGoogle Scholar
  13. Hobbs, C., Newton, L., Tennant, C., Rosen, A., & Tribe, K. (2002). Deinstitutionalization for long-term mental illness: A 6-year evaluation. Australian and New Zealand Journal of Psychiatry, 36, 60–66.PubMedCrossRefGoogle Scholar
  14. Janca, A., & Lee, A. (2002). Continuity of life interview manual. Perth: The University of Western Australia.Google Scholar
  15. Johnstone, E. C. (1991). Disabilities and circumstances of schizophrenic patients—a follow-up study. British Journal of Psychiatry, 159(Suppl 13), 5–46.Google Scholar
  16. Kuehner, C., & J. E. Cooper. (1999). Quality of life assessment in mental health research: A pilot study of the continuity of life interview. In: WPA section on epidemiology and public health symposium “from epidemiology to clinical practice”. Turku, Finland.Google Scholar
  17. Leff, J., & Trieman, N. (2000). Long-stay patients discharged from psychiatric hospitals—social and clinical outcomes after five years in the community. The TAPS Project 46. British Journal of Psychiatry, 176, 217–223.PubMedCrossRefGoogle Scholar
  18. Leff, J., Trieman, N., & Gooch, C. (1996). Team for the assessment of psychiatric services (TAPS) project 33: Prospective follow-up study of long-stay patients discharged from two psychiatric hospitals. American Journal of Psychiatry, 153(10), 1318–1324.PubMedGoogle Scholar
  19. Love, A. (1998). St Vincent’s community care unit—service goals and objectives. Melbourne: St Vincent’s Mental Health Service Melbourne (unpublished document).Google Scholar
  20. Minichello, V., Sullivan, G., Greenwood, K., & Axford, R. (1999). Handbook for research methods in health sciences. Sydney: Addison Wesley Longman Australia Pty Ltd.Google Scholar
  21. Mueser, K. T., & Bond, G. R. (2000). Psychosocial treatment approaches for schizophrenia. Current Opinion in Psychiatry, 13, 27–35.CrossRefGoogle Scholar
  22. Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin, 34, 37–74.Google Scholar
  23. Nelson, G., Brent Hall, G., & Walsh-Bowers, R. (1999). Predictors of the adaptation of people with psychiatric disabilities in group homes, supportive apartments, and board-and-care homes. Psychiatric Rehabilitation Journal, 22, 381–389.Google Scholar
  24. Newton, L., Rosen, A., Tennant, C., Hobbs, C., Lapsley, H., & Tribe, K. (2000). Deinstitutionalization for long-term mental illness: an ethnographic study. Australian and New Zealand Journal of Psychiatry, 34, 484–490.PubMedCrossRefGoogle Scholar
  25. Patton, M. Q. (2002). Qualitative research evaluation methods (3rd ed.). Thousand Oaks, California: Sage Publications.Google Scholar
  26. Priebe, S., & Turner, T. (2003). Reinstitutionalisation in mental health care. British Medical Journal, 326, 175–176.PubMedCrossRefGoogle Scholar
  27. Rapp, C., & Goscha, R. C. (2006). The strengths model (2nd ed.). New York: Oxford University Press.Google Scholar
  28. Rice, P. L., & Ezzy, D. (1999). Qualitative research methods: A health focus. Melbourne: Oxford University Press.Google Scholar
  29. Rosen, A., Hadzi-Pavlovic, D., & Parker, G. (1986). The life skills profile: A measure assessing function and disability in schizophrenia. Schizophrenia Bulletin, 12, 604–630.Google Scholar
  30. Salzer, M. S., & Shear, S. L. (2002). Identifying consumer-provided benefits in evaluations of consumer-delivered services. Psychiatric Rehabilitation Journal, 25, 281–288.PubMedGoogle Scholar
  31. Solomon, P., & Draine, J. (2001). The state of knowledge of the effectiveness of consumer provided services. Psychiatric Rehabilitation Journal, 25, 20–27.PubMedGoogle Scholar
  32. Stein, L. I., & Test, M. A. (1980). Alternative mental hospital treatment I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.PubMedGoogle Scholar
  33. Trauer, T. (2001). Symptom severity and personal functioning among patients with schizophrenia discharged from long-term hospital care into the community. Community Mental Health Journal, 37, 145–155.PubMedCrossRefGoogle Scholar
  34. Trauer, T., Farhall, J., Newton, R., & Cheung, P. (2001). From long-stay psychiatric hospital to community care unit: Evaluation at 1 year. Social Psychiatry and Psychiatric Epidemiology, 36, 416–419.PubMedCrossRefGoogle Scholar
  35. Trieman, N., & Leff, J. (2002). Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community—TAPS project 44. British Journal of Psychiatry, 181, 428–432.PubMedCrossRefGoogle Scholar
  36. Turner, T., & Priebe, S. (2002). Forget community care—reinstitutionalisation is here. British Journal of Psychiatry, 181, 253.PubMedCrossRefGoogle Scholar
  37. Victorian Government Department of Health and Community Services. (1996). Victoria’s mental health service resources for case managers: Individual service planning. Melbourne: Victorian Government Department of Health and Community Services.Google Scholar
  38. Warner, R. (2003). Recovery from schizophrenia: Psychiatry and political economy (3rd ed.). London: Brunner-Routledge.Google Scholar
  39. Warner, R., & Mandiberg, J. (2003). Changing the environment of schizophrenia at the community level. Australasian Psychiatry, 11(Suppl), S58–S64.CrossRefGoogle Scholar
  40. Wing, J., Beevor, A. S., Curits, R. H., Park, S. B. G., Hadden, S., & Burns, A. (1998). Health of the nation outcome scales: Research and development. British Journal of Psychiatry, 172, 11–18.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Centre for International Mental Health, School of Population HealthThe University of MelbourneParkvilleAustralia
  2. 2.Victorian Transcultural Psychiatry Unit, St. Vincent’s Health Melbourne, Level 2, Bolte WingSt. Vincent’s HospitalFitzroyAustralia
  3. 3.ORYGEN Research Centre, Department of PsychiatryThe University of MelbourneParkvilleAustralia

Personalised recommendations