Abstract
BackgroundA proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries.We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.MethodsWe undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.ResultsWe identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).ConclusionInstitutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
Highlights
A proportion of people with mental health problems require longer term care in a psychiatric or social care institution
A total of 12,182 relevant articles were identified through the search strategy
Since the majority of service users in these settings have a diagnosis of schizophrenia, specific interventions with high efficacy (CBT, family interventions involving psychoeducation and integrated supported employment) are key to positive outcomes and should be seen as priorities and delivered through programmes of complex interventions by specialist staff integrated within the same service
Summary
A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. The majority of these people have a diagnosis of schizophrenia [1] They are likely to have other problems which have complicated their recovery such as treatment resistance [2], cognitive impairment [3,4,5,6]; pre-morbid learning disability [7], substance misuse and other challenging behaviours [3,8]. Their illness impacts on their capacity to make informed choices for themselves and to actively participate in their care, putting them at risk of exploitation and abuse from others, including those who care for them. There are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries
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