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Regionalised Tertiary Psychiatric Residential Facilities

Published online by Cambridge University Press:  18 May 2011

Alain Lesage ,
David Groden ,
Elliot M. Goldner ,
Daniel Gelinas  and
Leslie M. Arnold
Alain Lesage*
Affiliation:
Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montréal, Québec (Canada)
David Groden
Affiliation:
Riverview Psychiatric Hospital, Port Coquitlam, British Columbia (Canada)
Elliot M. Goldner
Affiliation:
Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia (Canada)
Daniel Gelinas
Affiliation:
Centre de recherche Fernand-Seguin and Hôpital Louis-H. Lafontaine, affiliated to Université de Montréal, Montréal (Canada)
Leslie M. Arnold
Affiliation:
British Columbia Mental Health and Addiction Services. Agency of the Provincial Health Services Authority
*
Address for correspondence: Dr. A.D. Lesage, Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Unité 218, 7401 Hochelaga, Montréal, Québec HlN 3M5, (Canada). Fax: +1-514-251 5404 E-mail: [email protected]
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Summary

Aims – Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely – with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. Methods – This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. Results – In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. Conclusions – This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary Psychiatric Care Facilities have the potential to act as hubs of expertise not only for treatment, rehabilitation, community integration and ser-vice co-ordination for the severely mentally ill, but also for research and training.

Declaration of Interest: None.

Keywords

health services researchpsychiatric hospitalscommunity psychiatryhealth care economics and organizations
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 17 , Issue 1 , March 2008 , pp. 38 - 46
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

Allen, H., Baigent, B., Kent, A. & Bolton, J. (1993). Rehabilitation and staffing levels in a ‘new look’ hospital-hostel. Psychological Medicine 23, 203–211.CrossRefGoogle Scholar
Amaddeo, F., Beecham, J., Bonizzato, P., Fenyo, A., Knapp, M. & Tansella, M. (1997). The use of a case register to evaluate the costs of psychiatric care. Acta Psychiatrica Scandinavica 95, 189–198.CrossRefGoogle ScholarPubMed
Amaddeo, F., Grigoletti, L., de Girolamo, G., Picardi, A. & Santone, G. (2007). Which factors affect the costs of psychiatric residential care? Findings from the Italian PROGRES study. Acta Psychiatrica Scandinavica 115, 132–141.CrossRefGoogle ScholarPubMed
Barbato, A., D'Avanzo, B., Rocca, G., Amatulli, A. & Lampugnani, D. (2004). A study of long-stay patients resettled in the community after closure of a psychiatric hospital in Italy. Psychiatric Services 55, 67–70.CrossRefGoogle ScholarPubMed
Beecham, J. & Lesage, A. (1997). [Lessons in transferring resources: the system of fees per patient] in French. Santé Mentale au Quebec 22, 170–194.CrossRefGoogle Scholar
Becker, T., Gaite, L., Knapp, M., Knudsen, C., Leese, M., Ruggeri, M., Schene, A., Tansella, M., Thornicroft, G., Vazquez-Barquero, J.L., Welcher, B. & Van Wijngaarden, B. (2002). The iceberg tip and the rest. Mental health care for people with schizophrenia in five European centres. Epidemiologia e Psichiatria Sociale 11 (1), 6–11.CrossRefGoogle ScholarPubMed
Bridges, K., Davenport, S. & Goldberg, D. (1994). The need for hospital-based rehabilitation services. Journal of Mental Health 3, 205–212.CrossRefGoogle Scholar
Carpentier, N., Lesage, A., Goulet, J., Lalonde, P. & Renaud, M. (1992). Burden of care of families not living with young schizophrenic relatives. Hospital and Community Psychiatry 43, 38–43.Google Scholar
Croudace, T.J., Kayne, R., Jones, P.B. & Harrison, G.L. (2000). Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis. Psychological Medicine 30, 177–185.Google Scholar
de Girolamo, G., Picardi, A., Santone, G., Falloon, I., Morosini, P., Fioritti, A. & Micciolo, R. (2005). The severely mentally ill in residential facilities: a national survey in Italy. Psychological Medicine 35, 421–431.CrossRefGoogle ScholarPubMed
de Girolamo, G., Bassi, M., Neri, G., Ruggeri, M., Santone, G. & Picardi, A. (2007). The current state of mental health care in Italy: problems, perspectives, and lessons to learn. European Archives of Psychiatry and Clinical Neuroscience 257, 83–91.CrossRefGoogle ScholarPubMed
Drukker, M., Gunther, N., van Os, J. (2007). Disentangling associations between poverty at various levels of aggregation and mental health. Epidemiologia e Psichiatria Sociale 16, 3–9.CrossRefGoogle ScholarPubMed
Farhall, J., Trauer, T., Newton, R. & Cheung, P. (2000). Community Care Units Evaluation Project: One-year Report. Mental Health Branch, Department of Human Services: Victoria (Australia).Google Scholar
Garety, P.A. & Morris, I. (1984). A new unit for long-stay psychiatric patients: organization, attitudes and quality of care. Psychological Medicine 14, 183–192.CrossRefGoogle ScholarPubMed
Goldberg, D. (2000). Findings from London's Mental Health: a service in crisis. Acta Psychiatrica Scandinavica, Supplement No. 399, 57–60.CrossRefGoogle Scholar
Goldberg, D.P., Bridges, K., Cooper, W., Hyde, C., Sterling, C. & Wyatt, R. (1985). Douglas House: a new type of hostel ward for chronic psychotic patients. British Journal of Psychiatry 147, 383–388.CrossRefGoogle Scholar
Grigoletti, L., Amaddeo, F., de Girolamo, G., Picardi, A. & Gruppo Nazionale Progres (2004). [Costs of psychiatric residential care in Italy], in Italian. Epidemiologia e Psichiatria Sociale 13(4), 262–269.CrossRefGoogle Scholar
Gudeman, J.E. & Shore, M.F. (1984). Beyond deinstitutionalization. A new class of facilities for the mentally ill. New England Journal of Medicine 311, 832–836.CrossRefGoogle ScholarPubMed
HC/SC (1997). Best Practices in Mental Health Reform: Situational Analysis. Ottawa (Canada). Prepared for the Federal/Provincial/Territorial Advisory Network on Mental Health and published by Health Canada.Google Scholar
HC/SC (1998). Review of Best Practices in Mental Health Reform. Ottawa (Canada). Prepared for the Federal/Provincial/Territorial Advisory Network on Mental Health and published by Health Canada.Google Scholar
Hirsch, S. R. (1992). Services for the severe mentally ill-a planning blight? Psychiatric Bulletin 16, 673–675.CrossRefGoogle Scholar
Hobbs, C., Tennant, C., Rosen, A., Newton, L., Lapsley, H.M., Tribe, K. & Brown, J.E. (2000). Deinstitutionalisation for long-term mental illness: a 2-year clinical evaluation. Australian and New Zealand Journal of Psychiatry 34, 476–483.CrossRefGoogle ScholarPubMed
Hobbs, C., Newton, L., Tennant, C., Rosen, A. & Tribe, K. (2002). Deinstitutionalization for long-term mental illness: a 6-year evaluation. Australian and New Zealand Journal of Psychiatry 36, 60–66.CrossRefGoogle ScholarPubMed
Hyde, C., Bridges, K., Goldberg, D., Lowson, K., Sterling, C. & Faragher, B. (1987). The evaluation of a hostel ward. A controlled study using modified cost-benefit analysis. British Journal of Psychiatry 151, 805–812.CrossRefGoogle Scholar
Johnson, S., Ramsay, R., Thornicroft, G., Brooks, L., Lelliott, P., Peck, E., Smith, H., Chisholm, D., Audini, B., Knapp, M. & Goldberg, D. (Eds.) (1997). London's Mental Health: The Report to the King's Fund London Commission. King's Fund Publishing: London.Google Scholar
Knapp, M., Beecham, J., Anderson, J., Dayson, D., Leff, J., Margolius, O., O'Driscoll, C. & Wills, W. (1990). The TAPS project. 3: Predicting the community costs of closing psychiatric hospitals. British Journal of Psychiatry 157, 661–670.CrossRefGoogle ScholarPubMed
Lapsley, H.M., Tribe, K., Tennant, C., Rosen, A., Hobbs, C. & Newton, L. (2000). Deinstitutionalisation for long-term mental illness: cost differences in hospital and community care. Australian and New Zealand Journal of Psychiatry 34, 491–495.CrossRefGoogle ScholarPubMed
Lesage, A. (1997). [The role of psychiatric hospitals] in French. Santé Mentale au Quebec 22, 25–32.Google Scholar
Lesage, A. (2001) Towards benchmarks for sheltered housing places and at what costs? Annual meeting of the Canadian Psychiatric Association, Montreal.Google Scholar
Lesage, A.D., Clerc, D., Uribe, I., Cournoyer, J., Fabian, J., Tourjman, V., Van Haaster, I. & Chang, C.H. (1996). Estimating local-area needs for psychiatric care: a case study. British Journal of Psychiatry 169, 49–57.CrossRefGoogle ScholarPubMed
Lesage, A.D., Gelinas, D., Robitaille, D., Dion, E., Frezza, D. & Morissette, R. (2003). Toward benchmarks for tertiary care for adults with severe and persistent mental disorders. Canadian Journal of Psychiatry 48, 485–492.CrossRefGoogle ScholarPubMed
Lesage, A., Groden, D., Ohana, P. & Goldner, E. (2006). Seven Oaks and South Hills Projects - Year 2 Assessment Report (Draft). Riverview Hospital (Vancouver BC) & Louis-H. Lafontaine Hospital: Montreal, QC.Google Scholar
MacFarlane, D., Fortin, P., Fox, J., Gundry, S., Oshry, J. & Warren, E. (1997). Clinical and human resource planning for the downsizing of psychiatric hospitals: the British Columbia experience. Psychiatric Quarterly 68, 25–42.Google Scholar
Mansell, J., Beadle-Brown, J., Knapp, M. & Fernandez, J.L. (2007). Comparative cost analysis: Community-based services as an alternative to institutions. Research commissioned by the European Commission: Employment, Social Affairs and Equal Opportunities DG.Google Scholar
Marcelis, M, Navarro-Mateu, F., Murray, R., Selten, J.P. & Van Os, J. (1998). Urbanization and psychosis: a study of 1942-1978 birth cohorts in The Netherlands. Psychological Medicine 28, 871–879.CrossRefGoogle ScholarPubMed
McCrone, P., Johnson, S. & Thornicroft, G. (2001). Predicting the costs of community care for individuals with severe mental illness in South London. Schizophrenia Bulletin 27, 653–660.CrossRefGoogle ScholarPubMed
MSSSQ (2005). La force des liens: Plan d'action en santé mentale 2005-2010. Ministere de la Santé et des Services Sociaux du Gouvernement du Quebec.Google Scholar
Newton, T.E. & Schieldrop, P. (2005). [Seven Oaks: a new look at tertiary care] in French. Santé Mentale au Quebec 30, 31–45.CrossRefGoogle Scholar
PHSA (2005). Regional Tertiary Care: an Early Assessment of Patient Transfers from Riverview to South Hills and Seven Oaks. Provincial Health Services Authority: Victoria (BC).Google Scholar
Picardi, A., de Girolamo, G., Santone, G., Falloon, I., Fioritti, A., Micciolo, R., Morosini, P. & Zanalda, E. (2006). The environment and staff of residential facilities: findings from the Italian ‘Progres’ national survey. Community Mental Health Journal 42, 263–279.CrossRefGoogle ScholarPubMed
Pijl, Y.J., Sytema, S., Barels, R. & Wiersma, D. (2002). Costs of deinstitutionalization in a rural catchment area in The Netherlands. Psychological Medicine 32, 1435–1443.CrossRefGoogle Scholar
Rapp, C.A., Bond, G.R., Becker, D.R., Carpinello, S.E., Nikkei, R.E. & Gintoli, G. (2005). The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Mental Health Journal 41, 347–363.CrossRefGoogle ScholarPubMed
Reid, Y. & Garety, P.A. (1996). A hostel-ward for new long stay patients: Sixteen years’ progress. Journal of Mental Health 5, 77–89.CrossRefGoogle Scholar
Reinharz, D., Contandriopoulos, A.P. & Lesage, A.D. (2000). Organizational analysis of deinstitutionalization in a psychiatric hospital. Canadian Journal of Psychiatry 45, 539–543.Google Scholar
Rothbard, A. B. & Kuno, E. (2000). The success of deinstitutionalization. Empirical findings from case studies on state hospital closures. International Journal of Law and Psychiatry 23, 329–344.CrossRefGoogle ScholarPubMed
Rothbard, A.B., Schinnar, A.P., Hadley, T.P., Foley, K.A. & Kuno, E. (1998). Cost comparison of state hospital and community-based care for seriously mentally ill adults. American Journal of Psychiatry 155, 523–529.Google Scholar
Shepherd, G. (1995). The ‘ward-in-a-house': residential care for the severely disabled. Community Mental Health Journal 31, 53–69.CrossRefGoogle ScholarPubMed
Smith, P., Sheldon, T.A. & Martin, S. (1996). An index of need for psychiatric services based on in-patient utilisation. British Journal of Psychiatry 169, 308–316 (Discussion 317-321).CrossRefGoogle ScholarPubMed
Starkey, D. & Leadholm, B.A. (1997). PRISM: the Psychiatric Rehabilitation Integrated Service Model a public psychiatric hospital model for the 1990s. Administration and Policy in Mental Health 24, 497–508.CrossRefGoogle Scholar
Staufenberg, E. & Bridges, K. (1991). High Elms: a hostel-ward which closed after four years. Psychiatric Bulletin, 15, 670–672.Google Scholar
Thornicroft, G. & Bebbington, P. (1989). Deinstitutionalisation: from hospital closure to service development. British Journal of Psychiatry 155,739–753.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Tansella, M. (2003). What Are the Arguments for Community-based Mental Health Care? World Health Organization: Copenhagen.Google Scholar
Trauer, T., Farhall, J., Newton, R. & Cheung, P. (2001). From long-stay psychiatric hospital to Community Care Unit: evaluation at 1 year. Social Psychiatry and Psychiatric Epidemiology 36, 416–419.CrossRefGoogle ScholarPubMed
Trieman, N. & Leff, J. (2002). Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community. TAPS Project 44. British Journal of Psychiatry 181, 428–432.CrossRefGoogle ScholarPubMed
Trieman, N., Hughes, J. & Leff, J. (1998). The TAPS Project 42: the last to leave hospital-a profile of residual long-stay populations and plans for their resettlement. Team for the Assessment of Psychiatric Services. Ada Psychiatrica Scandinavica 98, 354–359.CrossRefGoogle Scholar
Tmdel, J.F. & Lesage, A.D. (2006). Care of patients with the most severe and persistent mental illness in an area without a psychiatric hospital. Psychiatric Services 57, 1765–1770.Google Scholar
van Wijngaarden, B., Schene, A., Koeter, M., Becker, T., Knapp, M., Knudsen, H.C., Tansella, M., Thornicroft, G., Vazquez-Barquero, J.L., Lasalvia, A. & Leese, M. (2003). People with schizophrenia in five countries: conceptual similarities and intercultural differences in family caregiving. Schizophrenia Bulletin 29, 573–586.CrossRefGoogle ScholarPubMed
Warner, R., de Girotamo, G., Belelli, G., Bologna, C., Fioritti, A. & Rosini, G. (1998). The quality of life of people with schizophrenia in Boulder, Colorado, and Bologna, Italy. Schizophrenia Bulletin 24, 559–568.CrossRefGoogle ScholarPubMed
Wasylenki, D., Goering, P., Cochrane, J., Durbin, J., Rogers, J. & Prendergast, P. (2000). Tertiary mental health services: I. Key concepts. Canadian Journal of Psychiatry 45, 179–184.Google Scholar
Wing, J.K. (1994). Mental illness. In Health Care Needs Assessment: The Epidemiologically Based Needs Assessment Reviews (ed. Stevens, A. and Raftery, J.). Radcliffe Press: Oxford.Google Scholar
Wing, J.K., Brewin, C.R. & Thornicroft, G. (2001). Defining mental health needs. In Measuring Mental Health Needs, 2nd ed. (ed. Thornicroft, G.). The Royal College of Psychiatrists: London.Google Scholar
Wykes, T. (1982). A hostel-ward for ‘new’ long-stay patients: an evaluative study of ‘a ward in a house’. Psychological Medicine 2, 57–97.Google ScholarPubMed
Wykes, T. & Wing, J.K. (1982). A ward in a house: accommodation for ‘new’ long-stay patients. Ada Psychiatrica Scandinavia 65, 315–330.Google Scholar