Abstract
There has been a resurgence of interest in mental health rehabilitation over the past decade, as it became increasingly clear that alternative services were not able to cater for the needs of patients with chronic and complex mental health issues. The study of a cohort of 80 clients was conducted in a 40-bed-inpatient rehabilitation unit retrospectively over a 1-year period, and aimed at describing the service-users’ characteristics, source of referrals and discharge destinations, along with examining the impact of an integrated medical model with psychosocial approach on Length of Stay (LOS); and investigating the sustenance of favorite outcomes over the 6-month period following discharge. Moreover, the quality of service provision on the unit was examined using QuIRC (Quality Indicator for Rehabilitative Care). The bio-psychosocial intervention model resulted in a significant reduction of LOS (p < .0001). The majority of patients were discharged to a less restrictive environment; revolving door admissions were significantly reduced, as well as the utilization of other psychiatric services (acute inpatient, p < .0001, short stay unit, p < .0001, and emergency room for mental health reasons p < .005). The quality of care provided was well above comparable average in some domains but slightly less in others. In the current climate of outcome driven services, we have demonstrated the effectiveness of an integrated model that appears to be prospectively sustainable. Investing resources and efforts on effective psychiatric rehabilitation programs for patients with enduring mental illness and complex needs, improves quality and economics that resonates throughout the wider scope of psychiatric services.
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References
Munich RL, Lang E. The boundaries of psychiatric rehabilitation. Hosp Community Psychiatry. 1993;44(7):661–5.
Killaspy H, Harden C, Holloway F, King M. What do mental health rehabilitation services do and what are they for? A national survey in England. J Ment Health. 2009;14(2):157–65. doi:10.1080/09638230500060144.
Department of Health, UK. Liberating the NHS: transparency in outcomes. 2011. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213789/dh_123138.pdf. Retrieved 25 Nov 2016.
Livingston MG, Bryson A. The Glasgow rehabilitation survey. Br J Psychiatry. 1989;154:620–4.
Choosing Wisely Canada. 2015. http://www.choosingwiselycanada.org/recommendations/psychiatry/. Retrieved 30 Nov 2015.
Killaspy H, King M, Wright C. Study protocol for the development of a European measure of best practice for people with long term mental health problems in institutional care (DEMoBinc). BMC Psychiatry. 2009;. doi:10.1186/1471-244X-9-36.
Taylor TL, Killaspy H, Wright C. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry. 2009;. doi:10.1186/1471-244X-9-55.
Turton P, Wright C, White S. Promoting recovery in long-term mental health institutional care: an international Delphi study. Psychiatr Serv. 2010;61:293–9. doi:10.1176/appi.ps.61.3.293.
Killaspy H, White S, Wright C. Association between service user experiences and staff rated quality of care in European facilities for people with longer term mental health problems. PLoS ONE. 2012;7(6):e38070.
Killaspy H, White S, Wright C. The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems. BMC Psychiatry. 2011;. doi:10.1186/1471-244X-11-35.
Statistics Canada. Table 109-5355—estimates of population (2011 Census and administrative data), by age group and sex for July 1st, Canada, provinces, territories, health regions (2015 boundaries) and peer groups, annual (number). http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1095355. Retrieved 21 Aug 2016.
National Institute of Health and Care Clinical Excellence (NICE). http://www.nice.org.uk/guidance/CG178/chapter/1Recommendations#subsequent-acute-episodes-of-psychosis-or-schizophrenia-and-referral-in-crisis-2. Retrieved 30 Nov 2015.
Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines. 11th ed. London: Wiley-Blackwell; 2012. p. 11–151.
Stroup TS, Gerhard T, Crystal S, Huang C, Olfson M. Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia. Am J Psychiatry. 2016;173(2):166–73. doi:10.1176/appi.ajp.2015.15030332.
Kelly DL, Conley RR, Feldman S, Yu Y, McMahon RP, Richardson CM. Adjunct divalproex or lithium to clozapine in treatment-resistant schizophrenia. Psychiatr Q. 2006;77(1):81–95. doi:10.1007/s11126-006-7963-9.
Rummel C, Kissling W, Leucht S. Antidepressants for the negative symptoms of schizophrenia. Cochrane Database Syst Rev. 2006; 19(3):CD005581. doi:10.1002/14651858.CD005581.pub2.
Centorrino F, Goren JL, Hennen J, Salvatore P, Kelleher JP, Baldessarini RJ. Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry. 2004;161:700–6. doi:10.1176/appi.ajp.161.4.700.
McCreadie RG, Wilson AO, Burton LL. The Scottish survey of ‘new chronic’ inpatients. Br J Psychiatry. 1983;143:564–71.
Lewis S, Lieberman J. CATIE and CUtLASS: can we handle the truth? Br J Psychiatry. 2008;192(3):161–3. doi:10.1192/bjp.bp.107.037218.
Naber D, Lambert M. The CATIE and CUtLASS studies in schizophrenia: results and implications for clinicians. CNS Drugs. 2009;23(8):649–59. doi:10.2165/00023210-200923080-00002.
Manschreck TC, Boshes RA. The CATIE schizophrenia trial: results, impact, controversy. Harv Rev Psychiatry. 2007;15(5):245–58. doi:10.1080/10673220701679838.
Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009;2009(373):31–41. doi:10.1016/S0140-6736(08)61764-X.
Leucht S, Komossa K, Rummel-Kluge C, Corves C, Hunger H, Schmid F, Asenjo Lobos C, Schwarz S, Davis JM. A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia. Am J Psychiatry. 2009;166(2):152–63. doi:10.1176/appi.ajp.2008.08030368.
Essock SM, Schooler NR, Scott Stroup T, McEvoy JP. Effectiveness of switching from antipsychotic polypharmacy to monotherapy. Am J Psychiatry. 2011;168:702–8. doi:10.1176/appi.ajp.2011.10060908.
Killaspy H, Zis P. Predictors of outcomes for users of mental health rehabilitation services: a 5-year retrospective cohort study in inner London, UK. Soc Psychiatry Psychiatr Epidemiol. 2013;48(6):1005–12. doi:10.1007/s00127-012-0576-8.
Dick PH. Psychiatric inpatient rehabilitation: is there a future? Int J Rehabil Res. 1990;13(2):119–26.
Killaspy H, Marston L, Omar RZ, Green N, Harrison I, Lean M, Holloway F, Craig T, Leavey G, King M. Service quality and clinical outcomes: an example from mental health rehabilitation services in England. Br J Psychiatry. 2013;202(1):28–34. doi:10.1192/bjp.bp.112.114421.
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The Authors express their gratitude to the multidisciplinary team on the Rehabilitation Unit. Their exemplary dedications, endeavors and unlimited support have played a pivotal role in enabling rehabilitative recovery and community reintegration for patients with severe mental illness.
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Awara, M.A., Simon, P., Lewis, N. et al. Psychiatric Rehabilitation: Quality of Care and Clinical Effectiveness. J. Psychosoc. Rehabil. Ment. Health 4, 61–71 (2017). https://doi.org/10.1007/s40737-017-0082-0
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DOI: https://doi.org/10.1007/s40737-017-0082-0