Housing services for people with mental disorders in England: patient characteristics, care provision and costs.

BACKGROUND AND AIMS: Since de-institutionalisation, housing services have taken a central role in the care of patients with severe mental illness. Yet, little is known about the characteristics of patients in different housing services, what care they receive, and what costs are generated. This study aimed to assess patient characteristics, care provision and costs in different types of housing services in England. METHODS: In 12 representative local areas in England, 250 housing services were randomly selected. Information on services, characteristics of randomly selected patients and care received were obtained from managers. RESULTS: Data from 153 services (61% response rate) and 414 patients were analysed. Most patients receive support with activities of daily living and are involved in some sort of occupational activities. 52% have a care co-ordinator in a community mental health team. Care provision and costs differed significantly between care homes, supported housing services and floating support services. CONCLUSIONS: Quality standards may have to be defined and applied to ensure that all patients in housing services receive appropriate care. More input of mental health services may be required for the rehabilitation and recovery of patients.

How to select representative geographical areas in mental health service research: a method to combine different selection criteria.

BACKGROUND: Mental health service research can require the selection of representative geographical areas for data collection. This study designed and tested a new method of combining different relevant selection criteria within the context of a survey of housing services for people with mental health disorders in England. METHODS: Six criteria were considered relevant to select areas for the survey: deprivation, urban-ness, provision of community mental health care, residential care provision, total mental health care spend and pressure on housing generally. A measure was identified for each criterion and established for each of 166 local areas. Variables were converted to standardised scores and multi-dimensional scaling undertaken to produce a single axis representing all six variables. Study sites were chosen from this. Identifying the spread of the constituent variables among the finally selected areas we established how successfully the resulting selection represented each of the selection criteria. Reliability analyses were performed on the rank positions of each area. RESULTS: The measures were converted into one axis, and all areas were ranked according to the score on that specifically developed new axis. The scores on the axis showed good reliability when single criteria were eliminated from the equation. The finally selected six areas demonstrated a reasonable spread of scores of each of the constituent variables. CONCLUSION: Converting several relevant criteria into one score is a feasible approach to ranking geographical areas to assist in identifying small samples that are arguably representative. The method may be used widely in similar research, but requires the availability of reliable data on relevant selection criteria.

Patient-reported outcomes in schizophrenia.

BACKGROUND: Patient-reported outcomes are increasingly used to evaluate the care of people with schizophrenia. AIMS: To review established and emerging patient-reported outcomes in schizophrenia research, assessmenttools and key findings. METHOD: A non-systematic review addressing relevant constructs, the associated scales and key empirical findings. RESULTS: Patient-reported outcomes in schizophrenia relate either to evaluation of illness and benefit from treatment or to resilience of the self. Of the former, needs for care, treatment satisfaction and the therapeutic relationship are most common. Less common are symptoms, insight, attitude towards medication, and clinical communication. Increasing expectations of treatment have led to new measures assessing resilience ofthe self, including empowerment, self-esteem, sense of coherence and recovery. Scores of different patient-related outcomes overlap and are influenced by a general tendency, largely influenced by mood, for more or less positive appraisal. CONCLUSIONS: The conceptual and empirical basis for different patient-reported outcomes varies, with most data available for treatment satisfaction. More than one such outcome should be used only if there is a specific hypothesis. For new patient-reported outcomes, relative independence from existing constructs should be demonstrated.