Social inclusion of people with severe mental illness living in community housing programs.

OBJECTIVE: The authors investigated levels of social inclusion among service users of two types of psychiatric community housing programs in the Netherlands. METHODS: A large-scale cross-sectional survey was conducted that included service users of community housing programs (N=255) and their key workers (N=75). Data on social inclusion-participating in activities, receiving and making visits, and vocational participation-were collected through a service user diary. Univariate regression analyses were performed with the social inclusion variables as the dependent variables and type of housing program (supported independent living versus residential care) as the independent variable. RESULTS: Service users living independently were more likely to feel socially included, in terms of activities and visits, than residents. Type of housing program was not associated with vocational participation. CONCLUSIONS: Although service users living independently were more likely than residents to be socially included, their vocational participation was similar to that of residents. It seems that for both groups of service user, it is important to improve the availability of vocational interventions or programs.

Treatment plans in psychiatric community housing programs: do they reflect rehabilitation principles?

OBJECTIVE: This study examined the extent to which treatment plans of service users of community housing programs measure up to rehabilitation principles according to the Choose-Get-Keep model of psychiatric rehabilitation. The study evaluates whether these plans correspond with service-user and key-worker perspectives on unmet needs for care. METHOD: A representative sample of key workers and service users of 16 Dutch Regional Institutes for Residential Care (RIRCs) participated in a cross-sectional survey. Sociodemographic and clinical data and an assessment of needs for care of 240 service users were collected. In addition, we received an anonymous copy of each participant's most recent written treatment plan. First, we developed a method to measure adherence to rehabilitation principles of written treatment plans, based on the Choose-Get-Keep model of psychiatric rehabilitation. Next, treatment plans were screened on the degree of adherence, expressed in a score from 0 to 10 for overall quality, and correlated with needs for care. RESULTS: RIRCs mostly seem to succeed in sufficiently integrating rehabilitation principles in their treatment plans. Adherence to rehabilitation principles was neither associated with the service-user perspective nor with the key worker perspective on needs for care. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Rehabilitation principles are rather well documented in the majority of written treatment plans, although apparently without substantial consequences for needs for care among the service users. Further research is needed to validate our method and to investigate not only the adherence to rehabilitation principles in written treatment plans, but also in the actual care provision itself.

Supported housing and supported independent living in the Netherlands, with a comparison with England.

Research into community housing programs for people with severe mental illness is underexposed. The Dutch UTOPIA study describes characteristics of their service users, which may predict their allocation to either supported housing or supported independent living programs. Additionally, a comparison is made with English studies. 119 Care coordinators of Dutch residential care institutes and 534 service users participated in a cross-sectional survey which includes socio-demographic data, clinical data, measures of functioning, needs for care and quality of life. Differences between Dutch residents and independent living service users were small, making predictions of care allocation difficult. This similarity suggests a possible lack of methodical assessment in the allocation procedure of people who are eligible for residential housing or independent living programs. This is largely comparable to the English situation. In comparison with their English counterparts, Dutch service users have more met needs and are more engaged in occupational activities.

Residential care: Dutch and Italian residents of residential care facilities compared.

AIMS: Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their residential patient populations. METHODS: Data from the Dutch UTOPIA-study (UTilization & Outcome of Patients In the Association of Dutch residential care providers) and the Italian PROGRES-study were used. RESULTS: Dutch residents were more likely to suffer from substance or alcohol abuse than Italian residents. The latter were more likely to suffer from schizophrenia or a related disorder, less likely to have experienced mental hospital admissions and showed an overall shorter duration of stay in residential care facilities. Contrary to our expectations Dutch residents, who still have good access to long stay beds in mental hospitals, are not less disabled than Italian residents. Finally, the number of beds in residential care facilities per 10,000 inhabitants in the Netherlands is twice (6) as high as in Italy (3). CONCLUSIONS: The Italian and Dutch deinstitutionalisation processes have resulted in a different availability in the number of residential beds. However, it did not influence the overall level of functioning of both residential populations.