Abstract
BackgroundAs in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users’ characteristics and experiences of care.MethodsAll longer term mental health units in Portugal providing on-site staffed support for at least 12 h per day were assessed with the Quality Indicator for Rehabilitative Care (QuIRC), a standardised tool completed by the unit manager. The QuIRC rates seven domains of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self/Management and Autonomy, Recovery Based Practice, Social Inclusion, and Human Rights). A random sample of service users were interviewed using standardised measures of autonomy, experiences of care and quality of life.ResultsMost (60 %) of the 42 units were in Lisbon and surrounding districts with 50 % based in the community and 50 % in hospital settings. They had a mean of 11.5 beds. Service users (n = 278) were mainly men (66.2 %), with a diagnosis of schizophrenia (72.7 %), and a mean age of 49.4 years. Community units scored higher than hospital units on the Living Environment, Treatments and Interventions, and Self-Management and Autonomy domains of the QuIRC. Increased service user age was negatively associated with all but one domain. All QuIRC domains were positively associated with service users’ autonomy and experiences of care.ConclusionsInvesting in better quality, community based mental health facilities is associated with better outcomes for service users who require longer term support.
Highlights
As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal
In community facilities it was more frequent that users were not available for the interview because of other activities, while in the hospital units it was more frequent for users to decline participation or to have high cognitive impairment preventing interview
It is encouraging that the quality ratings (QuIRC domain scores) were similar to the average scores across Europe, our findings suggest some important areas for improvement, especially with regard to Recovery Based Practice and Therapeutic Environment
Summary
As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Following recommendations from the European Commission’s Green Paper [1], most European countries have made significant advances in the development of community based mental health services [2]. The development of community services for the treatment and rehabilitation of people with longer term mental health problems is currently a priority across Europe [3]. This includes appropriately supported accommodation in urban residential areas. Moving from a psychiatric institution to community-based care has been associated with improvements in psychological, physical and social health and wellbeing [6, 7]
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