Does a community based recovery service reduce inpatient bed days?

OBJECTIVE: Increasing options for the delivery of community-based care may be one way to reduce inpatient bed pressures. This study set out to examine the effect of community-based step up/step down (SUSD) care on hospital usage for service users with multi-service usage. METHODS: A retrospective audit was undertaken of the medical records of all individuals admitted to a SUSD unit over a 2-year period, calculating inpatient bed days for the 12 months prior to, and the 12 months after, the SUSD admission. RESULTS: There was a statistically nonsignificant decrease in bed days in the 12 months following admission. CONCLUSION: It is possible that inpatient bed day reduction may not be an appropriate outcome measure for a service built on principles of personal recovery. How to translate recovery-outcomes to justifiable financial benefits for services requires further consideration and alignment of values with reporting measures.

A narrative review of mental health support for people during transition from incarceration to community: the grass can be greener on the other side of the fence.

BACKGROUND: Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. AIMS: This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. METHOD: We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. RESULTS: We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. CONCLUSIONS: Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives.

Community Treatment Orders (CTOs): a demographic cross-sectional analysis.

OBJECTIVES: Existing research on Community Treatment Orders (CTOs) questions what purposes they serve, for whom and for how long. This study aimed to identify demographics of the CTO population, differences between individuals who require short CTOs from those who require repeat CTO and clinician-determined factors which influence these decisions. METHODS: Using a cross-sectional snapshot method, 301detailed audits were analysed for frequencies and relationships between variables. RESULTS: People on CTOs (n = 301) comprised 9% of the community mental health population (n = 3268); 21% (n = 62) having it be their first CTO, 50% (n = 149) on repeat CTOs (continuous) and 29% (n = 85) on second episode or more of CTOs (non-continuous). There were 82% (n = 231) of people on a CTO who had a primary diagnosis of schizophrenia. There was a higher occurrence of males with co-existing factors of aggression and current substance misuse. Age had a relationship with length of actual and predicted CTOs. CONCLUSIONS: Men of middle age, with a diagnosis of schizophrenia, a history of aggression, current substance misuse and reported previous CTO efficacy are the primary individuals predicted to require ongoing CTOs. Improving CTO efficacy should focus on providing targeted intervention for this group and a closer analysis of the use of CTOs in other groups.