For people with grave psychiatric conditions, consumer-managed residential programs may be the way to go, a new study suggests.
Not only are the daily costs of these facilities cheaper than
psychiatric hospitals, but patients of these programs may get healthier
than their counterparts in traditional, locked institutions, according
to the study, results of which have been published online by the American Journal of Community Psychology.
More specifically, the study's authors found that participants in a
consumer-managed crisis residential program (CRP) experienced
significantly greater improvement on several interviewer-rated and
self-reported psychopathology measures than did participants assigned
to a locked, inpatient psychiatric facility (LIPF). They also found
that service satisfaction was dramatically higher among patients at the
CRP.
Researchers surveyed and tested the study's participants when they
entered their randomly assigned facilities, then 30 days, six months
and a year after admission. Based on the results of these interviews,
the study's authors have concluded that less restrictive crisis
residential centers are at least as effective as standard care for
adults with psychiatric crises who are not considered a danger to
others.
"What is clear from the results is that these patients could do as well or better in a less restrictive environment," said Tom Greenfield , the study's first author and center director of the Alcohol Research Group at the Public Health Institute.
"This raises an important question about why people in mental health
crisis need to be committed to a large, expensive and locked inpatient
facility when a small, well-run consumer-managed program can work as
well or better?"
Conducted by a team of researchers from the Public Health Institute, the University of Arizona, Veterans Affairs and Stanford University Medical Centers, the study surveyed 393 mental health patients admitted during crises.
To be included in the study, participants had to have been brought to a
county-operated crisis clinic and either been diagnosed with a major
mental disorder, admitted by a psychiatrist for "serious symptoms" such
as hallucinations, or deemed a danger to themselves by the admitting
psychiatrist. Those deemed a danger to others were excluded from the
study. Participants provided their informed consent to participate in
the study, then were randomly assigned to a CRP or LIPF.
The CRP was an unlocked, six-bed hostel that had an accessible garden
and other shared amenities such as a kitchen and laundry room. The
CRP's program director and day-to-day staff were all mental health
consumers who had community college training, a strong understanding of
local mental health resources, and basic helping skills. Part-time
psychiatrists were available to prescribe medications.
The LIPF was a county-operated and professionally staffed facility that
operated on a medical model of treatment. All of its 80 beds were on
locked units. This was a modern facility with windows looking onto
atrium spaces. It was located on county-owned property only a hundred
yards from the CRP and characterized by high staff morale.
John Buck, who directs the non-profit mental health agency Turning
Point Community Programs, believes that the two programs' differences
explain the study results. Turning Point operates a CRP in Sacramento,
CA.
"In a smaller setting, things are more intimate," said Buck. "People
get the sense that they are being listened to. And because we staff our
facility with people who are in recovery, they can transmit a greater
sense of compassion and provide a model for how to get through. I think
this plays well for people's hopes that they can recover."
Acknowledging that some patients may require inpatient care, especially
if they refuse to take medications, Buck added, "What I hope people
will gain from this study is an understanding that crisis residential
programs can work and do work. CRPs are a valuable component of a
mental health treatment system."
Based on the results of this study, the authors recommend further
analyses by demographic and diagnostic subgroups to clarify which
patients do better in which settings. And given the difference in daily
costs between the CRP ($211) and LIPF ($665), the study's co-authors
have concluded that more comparative studies are needed to provide
definitive cost analyses.
Together with the State of California and the County of Sacramento, the Center for Mental Health Services
funded this study to address the need for more concrete data about
differing treatment options, said Risa Fox, a public health officer at
the Center for Mental Health Services.
"We are trying to obtain the evidence-based data to substantiate what
consumers are telling us about the value of these types of services,"
said Fox. "These findings have reinforced these perceptions and those
held by policy makers and administrators that peer managed services are
key to mental health transformation."
To access a copy of the online report, visit here.
Not only are the daily costs of these facilities cheaper than
psychiatric hospitals, but patients of these programs may get healthier
than their counterparts in traditional, locked institutions, according
to the study, results of which have been published online by the American Journal of Community Psychology.
More specifically, the study's authors found that participants in a
consumer-managed crisis residential program (CRP) experienced
significantly greater improvement on several interviewer-rated and
self-reported psychopathology measures than did participants assigned
to a locked, inpatient psychiatric facility (LIPF). They also found
that service satisfaction was dramatically higher among patients at the
CRP.
Researchers surveyed and tested the study's participants when they
entered their randomly assigned facilities, then 30 days, six months
and a year after admission. Based on the results of these interviews,
the study's authors have concluded that less restrictive crisis
residential centers are at least as effective as standard care for
adults with psychiatric crises who are not considered a danger to
others.
"What is clear from the results is that these patients could do as well or better in a less restrictive environment," said Tom Greenfield , the study's first author and center director of the Alcohol Research Group at the Public Health Institute.
"This raises an important question about why people in mental health
crisis need to be committed to a large, expensive and locked inpatient
facility when a small, well-run consumer-managed program can work as
well or better?"
Conducted by a team of researchers from the Public Health Institute, the University of Arizona, Veterans Affairs and Stanford University Medical Centers, the study surveyed 393 mental health patients admitted during crises.
To be included in the study, participants had to have been brought to a
county-operated crisis clinic and either been diagnosed with a major
mental disorder, admitted by a psychiatrist for "serious symptoms" such
as hallucinations, or deemed a danger to themselves by the admitting
psychiatrist. Those deemed a danger to others were excluded from the
study. Participants provided their informed consent to participate in
the study, then were randomly assigned to a CRP or LIPF.
The CRP was an unlocked, six-bed hostel that had an accessible garden
and other shared amenities such as a kitchen and laundry room. The
CRP's program director and day-to-day staff were all mental health
consumers who had community college training, a strong understanding of
local mental health resources, and basic helping skills. Part-time
psychiatrists were available to prescribe medications.
The LIPF was a county-operated and professionally staffed facility that
operated on a medical model of treatment. All of its 80 beds were on
locked units. This was a modern facility with windows looking onto
atrium spaces. It was located on county-owned property only a hundred
yards from the CRP and characterized by high staff morale.
John Buck, who directs the non-profit mental health agency Turning
Point Community Programs, believes that the two programs' differences
explain the study results. Turning Point operates a CRP in Sacramento,
CA.
"In a smaller setting, things are more intimate," said Buck. "People
get the sense that they are being listened to. And because we staff our
facility with people who are in recovery, they can transmit a greater
sense of compassion and provide a model for how to get through. I think
this plays well for people's hopes that they can recover."
Acknowledging that some patients may require inpatient care, especially
if they refuse to take medications, Buck added, "What I hope people
will gain from this study is an understanding that crisis residential
programs can work and do work. CRPs are a valuable component of a
mental health treatment system."
Based on the results of this study, the authors recommend further
analyses by demographic and diagnostic subgroups to clarify which
patients do better in which settings. And given the difference in daily
costs between the CRP ($211) and LIPF ($665), the study's co-authors
have concluded that more comparative studies are needed to provide
definitive cost analyses.
Together with the State of California and the County of Sacramento, the Center for Mental Health Services
funded this study to address the need for more concrete data about
differing treatment options, said Risa Fox, a public health officer at
the Center for Mental Health Services.
"We are trying to obtain the evidence-based data to substantiate what
consumers are telling us about the value of these types of services,"
said Fox. "These findings have reinforced these perceptions and those
held by policy makers and administrators that peer managed services are
key to mental health transformation."
To access a copy of the online report, visit here.
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