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The relationship between deinstitutionalization and quality of care in longer-term psychiatric and social care facilities in Europe: A cross-sectional study

Published online by Cambridge University Press:  23 March 2020

T. Taylor Salisbury ,
H. Killaspy  and
M. King
T. Taylor Salisbury*
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
H. Killaspy
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom
M. King
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom
*
*Corresponding author. Division of Psychiatry, University College London, London, United Kingdom. E-mail address:tatiana.salisbury@kcl.ac.uk (T. Taylor Salisbury).
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Abstract

Background

The process of deinstitutionalization (community-based care) has been shown to be associated with better quality of life for those with longer-term mental health problems compared to long stay hospitals. This project aimed to investigate the relationship between national progress towards deinstitutionalization and (1) quality of longer-term mental health care (2) service users’ ratings of that care in nine European countries.

Methods

Quality of care was assessed in 193 longer-term hospital- and community-based facilities in Bulgaria, Germany, Greece, Italy, the Netherlands, Poland, Portugal, Spain and the UK. Data on users’ ratings of care were collected from 1579 users of these services. Country level variables were compiled from publicly available data. Multilevel models were fit to assess associations with quality of care and service user experiences of care.

Results

Significant positive associations were found between deinstitutionalization and (1) five of seven quality of care domains; and (2) service user autonomy. A 10% increase in expenditure was associated with projected clinically important improvements in quality of care.

Conclusions

Greater deinstitutionalization of mental health mental health services is associated with higher quality of care and better service user autonomy.

Keywords

Psychiatry in EuropeQuality of careSocial and cross-cultural psychiatry
Type
Original article
Information
European Psychiatry , Volume 42 , May 2017 , pp. 95 - 102
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

Abbreviations: DEMoBinc, Development of a European Measure of Best Practice for People with Long Term Mental Illness in Institutional Care; QuIRC, Quality Indicator for Rehabilitative Care; MENDit, Mental Health Service Deinstitutionalization Measure; WHO, World Health Organization; DISC, Discrimination and Stigma Scale; FTE, full-time equivalent; AICc, corrected Akaike Information Criterion.

References

Leff, J., Trieman, N.Long-stay patients discharged from psychiatric hospitals: social and clinical outcomes after five years in the community. The TAPS Project 46. Br J Psychiatry 2000;176:217–223.CrossRefGoogle ScholarPubMed
McInerney, S.J., Finnerty, S., Avalos, G., Walsh, E.Better off in the community? A 5-year follow up study of long-term psychiatric patients discharged into the community. Soc Psychiatry Psychiatr Epidemiol 2010;45:469–473.CrossRefGoogle ScholarPubMed
Priebe, S., Hoffmann, K., Isermann, M., Kaiser, W.Do long-term hospitalised patients benefit from discharge into the community?. Soc Psychiatry Psychiatr Epidemiol 2002;37:387–392.CrossRefGoogle ScholarPubMed
Honkonen, T., Karlsson, H., Koivisto, A.-M., Stengård, E., Salokangas, R.K.Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland. Aust N Z J Psychiatry 2003;37:160–168.CrossRefGoogle ScholarPubMed
World Health Organization. Mental Health Atlas 2011. Geneva: World Health Organization; 2011.Google Scholar
Priebe, S., Badesconyi, A., Fioritti, A., Hansson, L., Kilian, R., Torres-Gonzales, F.et al.Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 2005;330:123–126.CrossRefGoogle ScholarPubMed
Sisti, D.A., Segal, A.G., Emanuel, E.J.Improving long-term psychiatric care: bring back the asylum. JAMA 2015;313:243–244.CrossRefGoogle ScholarPubMed
Killaspy, H., King, M., Wright, C., White, S., McCrone, P., Kallert, T.et al.Study protocol for the development of a European measure of best practice for people with long term mental health problems in institutional care (DEMoBinc). BMC Psychiatry 2009;9:36.CrossRefGoogle Scholar
Killaspy, H., White, S., Wright, C., Taylor, T.L., Turton, P., Kallert, T.et al.Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users’ views. PLoS One 2012;7:e38070.CrossRefGoogle ScholarPubMed
Priebe, S., Huxley, P., Knight, S., Evans, S.Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry 1999;45:7–12.CrossRefGoogle Scholar
Hatton, C., Emerson, E., Roberts, J., Gergory, N., Kessissoglou, S., Walsh, P.N.The Resident Choice Scale: a measure to assess opportunities for self-determination in residential settings. J IntellectDisabil Res 2004;48:103–113.CrossRefGoogle ScholarPubMed
Webb, Y., Clifford, P.I., Graham, P.A simple method of evaluating patients’ perceptions of their treatment and care. Bull Menninger Clin 1999;63:401.Google ScholarPubMed
Røssberg, J.I., Friis, S.Do the spontaneity and anger and aggression subscales of the Ward Atmosphere Scale form homogeneous dimensions? A cross-sectional study of 54 wards for psychotic patients. Acta Psychiatr Scand 2003;107:118–123.CrossRefGoogle ScholarPubMed
Taylor Salisbury, T., Killaspy, H., King, M.An international comparison of the deinstitutionalisation of mental health care: development and findings of the Mental Health Services Deinstitutionalisation Measure (MENDit). BMC Psychiatry 2016;16:54.CrossRefGoogle Scholar
World Health Organization. Mental Health Atlas 2005. Geneva: World Health Organization; 2005.Google Scholar
Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M.Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 2009;373:408–415.CrossRefGoogle ScholarPubMed
Akaike, H.Factor analysis and AIC. Psychometrika 1987;52:317–322.CrossRefGoogle Scholar
Priebe, S., Saidi, M., Want, A., Mangalore, R., Knapp, M.Housing services for people with mental disorders in England: patient characteristics, care provision and costs. Soc Psychiatry Psychiatr Epidemiol 2009;44:805–814.CrossRefGoogle ScholarPubMed
New horizons: a shared vision for mental health. London: Department of Health; 2009.Google Scholar
Royal College of Psychiatrists. Chaning Minds; 1998.Google Scholar
Department of Health UK. Transforming care: a national response to Winterbourne View Hospital: Department of Health Review Final Report. London. London: Department of Health; 2012.Google Scholar
Joint Commissioning Panel for Mental Health. Guidance for commissioners of rehabilitation services for people with complex mental health needs. London: Practical Mental Health Commissioning; 2012.Google Scholar
Hansson, L., Björkman, T.Are factors associated with subjective quality of life in people with severe mental illness consistent over time? – A 6-year follow-up study. Qual Life Res 2007;16:9–16.CrossRefGoogle ScholarPubMed
Eklund, M., Hansson, L., Ahlqvist, C.The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness. Commun Mental Health J 2004;40:465–477.CrossRefGoogle ScholarPubMed
Atkins, T., Meats, P., Sincock, C.Can we rehabilitate everyone? Psychiatr Bull 1991;15:10–12.CrossRefGoogle Scholar
Cullen, D., Carson, J., Holloway, F., Towey, A., Jumbo, A., Smellie, N.et al.Community and hospital residential care: a comparative evaluation. Irish J Psychol Med 1997;14:92–98.Google Scholar
Simpson, C.J., Hyde, C.E., Faragher, E.B.The chronically mentally ill in community facilities: a study of quality of life. Br J Psychiatry 1989;154:77–82.CrossRefGoogle ScholarPubMed
Wiersma, D., van Busschbach, J.Are needs and satisfaction of care associated with quality of life?. Eur Arch Psychiatry Clin Neurosci 2001;251:239–246.CrossRefGoogle ScholarPubMed
Marwaha, S., Johnson, S., Bebbington, P., Angermeyer, M.C., Brugha, T., Azorin, J.M.et al.Correlates of subjective quality of life in people with schizophrenia: findings from the EuroSC Study. J Nerv Mental Dis 2008;196.Google ScholarPubMed
Karastergiou, A., Mastrogianni, A., Gerogiadou, E., Kotrotsios, S., Mauratziotou, K.The reform of the Greek mental health services. J Mental Health 2005;14:197–203.CrossRefGoogle Scholar
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