Characteristics and Quality of Care of Residential Units for People with Long-term Mental Illness in Portugal

Abstract

Introduction In Portugal, following the National Mental Health Plan (2008-2017), an increasing number of residential units for people with severe mental illness has been developed. There are no studies assessing their functioning. Objectives To characterize the Portuguese residential units with high and medium support levels, their users, and the quality of care provided. Methods Portuguese residential units for the long-term mentally ill were assessed with the Quality Instrument for Rehabilitative Care (QuIRC) filled on-line by the managers. A random sample of service users was interviewed face-to-face with the Service User Interview. Results Forty-two units (100%) were included. The majority (54.8%) was in the community, single-sex (54.8%), staffed 24 hours a day (54.8%), and had 10 or less beds (61.9%), no limit in the LOS (88.1%), and no service users in involuntary commitment (93%). All units provided access to psychologists and social workers, the majority to psychiatrists and nurses (95.2% each), auxiliaries (88.1%), and occupational therapists (73.8%). Users assessed (n=278) had a mean age of 50±11 years, and were mainly men (66.2%), with a diagnosis of schizophrenia (72.7%), a mean GAF score of 64.3±15.1, and were living in the unit for a median of 4 years. Quality of care assessed by the QuIRC was significantly higher in community versus hospital units in the following dimensions: Living Environment (p=0.030), Treatments and Interventions (p=0.035), and Self-Management and Autonomy (p=0.019). Conclusions Residential facilities for people with severe mental illness provide better quality of care in some dimensions in community versus hospital units.