Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland
Tom Meehan A B E , Terry Stedman A B , Stephen Parker C D , Bretine Curtis A and Donna Jones AA Queensland Mental Health Benchmarking Unit, The Park, Centre for Mental Health, Locked Bag 500, Archerfield, Qld 4108, Australia. Email: Bretine.Curtis@health.qld.gov.au; Donna.Jones3@health.qld.gov.au; Terry.Stedman@health.qld.gov.au
B Department of Psychiatry, University of Queensland, Herston, Qld 4066, Australia.
C Rehabilitation Clinical Academic Unit, Metro South Addiction and Mental Health Service, 519 Kessels Road, MacGregor, Qld 4109, Australia. Email: Stephen.Parker@health.qld.gov.au
D School of Public Health, University of Queensland, Herston, Qld 4066, Australia.
E Corresponding author. Email: Tom.Meehan@health.qld.gov.au
Australian Health Review 41(2) 139-143 https://doi.org/10.1071/AH15207
Submitted: 3 November 2015 Accepted: 14 March 2016 Published: 28 April 2016
Journal Compilation © AHHA 2017 Open Access CC BY-NC-ND
Abstract
Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs.
Methods An audit of consumers (n = 240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning.
Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems.
Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more ‘step-down’ options to move patients on were available.
What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment.
What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs.
What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more ‘step-down’ options were available. Future planning initiatives need to focus on developing a greater array of community support options to facilitate the discharge of people from residential services.
Additional keywords: benchmarking, patient characteristics, service profile.
References
[1] Harris M, Buckingham B, Pirkis J, Groves A, Whiteford H. Planning estimates for the provision of core mental health services in Queensland 2007–2017. Aust N Z J Psychiatry 2012; 46 982–94.| Planning estimates for the provision of core mental health services in Queensland 2007–2017.Crossref | GoogleScholarGoogle Scholar | 22802553PubMed |
[2] Allison S, Bastiampillai T, Goldney R. Acute versus sub-acute care beds: should Australia invest in community beds at the expense of hospital beds? Aust N Z J Psychiatry 2014; 48 952–4.
| Acute versus sub-acute care beds: should Australia invest in community beds at the expense of hospital beds?Crossref | GoogleScholarGoogle Scholar | 25136059PubMed |
[3] Parker S, Siskind D, Harris M. Community based residential mental health services: what do we need to know. Aust N Z J Psychiatry 2015; 49 86–7.
| Community based residential mental health services: what do we need to know.Crossref | GoogleScholarGoogle Scholar | 25360002PubMed |
[4] Killaspy H. The ongoing need for local services for people with complex mental health problems. Psychiatr Bull 2014; 38 257–9.
| The ongoing need for local services for people with complex mental health problems.Crossref | GoogleScholarGoogle Scholar |
[5] Gonda T, Deane F. Predicting clinically significant change in an inpatient program for people with severe mental illness. Aust N Z J Psychiatry 2012; 46 651–8.
| Predicting clinically significant change in an inpatient program for people with severe mental illness.Crossref | GoogleScholarGoogle Scholar | 22528976PubMed |
[6] Craig T, Garety P, Power P, Rahaman N, Colbert S, Fornella-Ambrojo M, Dunn G. The Lambeth Early Onset (LEO) team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ 2004; 329 1067–71.
| The Lambeth Early Onset (LEO) team: randomised controlled trial of the effectiveness of specialised care for early psychosis.Crossref | GoogleScholarGoogle Scholar | 15485934PubMed |
[7] Trauer T, Farhall J, Newton R, Cheung P. From long-stay psychiatric hospital to community care unit: evaluation at 1 year. Soc Psychiatry Psychiatr Epidemiol 2001; 36 416–9.
| From long-stay psychiatric hospital to community care unit: evaluation at 1 year.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FjvFCntg%3D%3D&md5=7e0f8e6863bdf37d55358accd0ae8a73CAS | 11766972PubMed |
[8] Queensland Health. Community care unit: model of service delivery. Brisbane: Queensland Health; 2012.
[9] Meehan TJ, Stedman TJ, Neuendorf KE, Francisco ID, Neilson MG. Benchmarking Australia’s mental health services: is it possible and useful? Aust Health Rev 2007; 34 623–7.
| Benchmarking Australia’s mental health services: is it possible and useful?Crossref | GoogleScholarGoogle Scholar |
[10] Shepherd N, Meehan T, Davidson F, Stedman T. An evaluation of benchmarking initiative in extended treatment mental health services. Aust Health Rev 2010; 34 328–33.
| An evaluation of benchmarking initiative in extended treatment mental health services.Crossref | GoogleScholarGoogle Scholar | 20797366PubMed |
[11] Tabachnick B, Fidell L. Using multivariate statistics. 4th edn. Needham Heights, MA: Allyn & Bacon; 2001.
[12] Woods S. Chlorpromazine equivalent doses for newer atypical antipsychotics. J Clin Psychiatry 2003; 64 663–7.
| Chlorpromazine equivalent doses for newer atypical antipsychotics.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXls12ktb0%3D&md5=00f61905606b278767e74cd0b048464fCAS | 12823080PubMed |
[13] Buckingham W, Burgess P, Solomon S, Pirkis J, Eagar K. Developing a casemix classification for mental health services: summary. Canberra: Commonwealth Department of Health and Family Services; 1998.
[14] Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 1998; 172 11–18.
| Health of the Nation Outcome Scales (HoNOS). Research and development.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7ps1ehtg%3D%3D&md5=f925fa53a6683e4df86fd98f4589e39dCAS | 9534825PubMed |
[15] Parabiaghi A, Barbato A, D’Avanzo B, Erlicher A, Lora A. Assessing reliable and clinically significant change on the Health of the Nation Outcome Scales: method for displaying longitudinal data. Aust N Z J Psychiatry 2005; 39 719–45.
| Assessing reliable and clinically significant change on the Health of the Nation Outcome Scales: method for displaying longitudinal data.Crossref | GoogleScholarGoogle Scholar | 16050926PubMed |
[16] Meehan T, Stedman T, Robertson S, Drake S, King R. Do supported housing models improve clinical and social outcomes for people with severe mental illness? Aust N Z J Psychiatry 2011; 45 586–92.
| Do supported housing models improve clinical and social outcomes for people with severe mental illness?Crossref | GoogleScholarGoogle Scholar | 21534823PubMed |
[17] National Mental Health Commission (NHMC). Contributing lives, thriving communities: the national review of mental health programs and services. Sydney: NMHC; 2014.
