Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Client engagement

Abstract

Systematic observational measures of the minute-to-minute behaviour of severely and profoundly mentally handicapped people of comparable levels of dependency were taken in two types of residential unit to establish the level of engagement in activity. Higher engagement levels were found among those clients living in Wessex locally-based hospital units compared with those living in villas of a traditional mental handicap hospital. Thus, concern that such small “domestic” units, sited in the community among the people they serve, would not be a feasible alternative to traditional campus-type hospitals appear to be unfounded. Moreover, the prediction that traditional practices, such as grouping clients by clinical or diagnostic criteria and grouping living units to provide peer “support” to staff and supposed better access to specialists, are essential to the maintenance of high quality residential care is not borne out by the evidence. More attention needs to be paid to the important variables of staff deployment and scheduling of activities in the maintenance of high levels of client engagement in activity.