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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: alesage@ssss.gouv.qc.ca
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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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