Abstract
A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-patients who could be discharged to residential or long-term nursing care facilities. Program clinical professionals of regional residential facilities sent adapted standardized questionnaires to ward staff. Evaluators also collected the residential preferences of both staff and patients, and then made their own assessments. The 194 in-patients were mostly middle-aged single men. Over 80% had a psychosis diagnosis and half had judicial constraints. The staff evaluated that 71.1% could be discharged from hospital within 24 h. Of these, 55% could be referred to group resources with continuous 24 h, 7 days a week staff presence, 32% could be transferred to apartments with 7-day continuous or non-continuous staff presence, 12% could be transferred to institutional care and only 2% could be moved to an apartment of their own. Evaluator and ward staff residential preferences were highly similar, but differed with patient preferences, half of whom prefer their own apartment. Discrepancy between staff evaluations and patient preferences were higher for longer stay patients with more severe symptoms and comorbidity of personality disorders.
Highlights
A balanced mental health care system for severely and persistently mentally ill patients in a resource-rich country like Canada includes several treatment and rehabilitation components: community mental health team (CMHT), intensive home care intensive home care (IHC)— including intensive case-management team (ICM) and assertive community treatment team (ACT), residential facilities and long-term hospitalization, forensic psychiatric beds, as well as occupational facilities [1]
The project consisted of a cross-sectional survey that targeted two psychiatric hospitals with catchment-area acute care hospitalization responsibilities, nine general hospital psychiatric wards and one forensic mental health hospital all located in Montreal
The hospital staff completed a questionnaire adapted from five existing instruments [Canadian Psychosocial Rehabilitation (PSR) Toolkit, Nottingham Acute Beds Utilisation Schedule (NABUS), Level of Care Survey (NYLOCS), Riverview Patient Inventory (RPI), Consumer Housing Preference Survey (CHPS)]
Summary
A balanced mental health care system for severely and persistently mentally ill patients in a resource-rich country like Canada includes several treatment and rehabilitation components: community mental health team (CMHT), intensive home care intensive home care (IHC)— including intensive case-management team (ICM) and assertive community treatment team (ACT), residential facilities and long-term hospitalization, forensic psychiatric beds, as well as occupational facilities [1]. Over the past decades most industrialized countries have had similar experiences of downsizing or closing psychiatric hospital long-stay beds, and increasing acute care beds, CMHTs and residential facilities. This period has been characterized by insufficient funding, trans. Housing Orientations of Above-Average Psychiatric Inpatients institution to the judicial system and destitution into the streets of severely mentally ill patients and, more recently in Quebec, further cuts in CMHTs, acute care beds, and residential facilities due to budgetary constraints. The estimates did not take into account homeless mentally ill patients concentrated downtown Montreal, or prison inmates with psychosis [5]. The latter study estimated that 8% of Quebec prison inmates had previously received a diagnosis of schizophrenia while the yearly treated prevalence in the population is 0.4% [6]
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