Background
Methods
Measurement of outcomes
Measurement of service use and costs
Data management
Data analysis
Results
N = 362 | ||
---|---|---|
n or mean | % or (SD) | |
Socio demographics and diagnosis | ||
Male | 235 | 65 |
Age | 39 | (13) |
White | 324 | 90 |
Schizophrenia | 238 | 68 |
Schizoaffective disorder | 36 | 10 |
Bipolar disorder | 26 | 7 |
Other | 49 | 14 |
Contact with mental health services | ||
Time since first contact (years) median (IQR) | 12 | (6, 20) |
Previous admissions median (IQR) | 4 | (2, 7) |
Previous involuntary admissions median (IQR) | 2 | (0, 4) |
Length of current admission (months) median (IQR) | 18 | (9, 38) |
Length of current admission in rehabilitation unit (months) median (IQR) | 7 | (3, 15) |
Current admission involuntary | 250 | 71 |
Currently detained involuntary | 174 | 49 |
Previous admission to special hospital (ever) | 9 | 3 |
Previous admission medium secure unit (ever) | 30 | 9 |
Previous admission low secure unit (ever) | 70 | 20 |
Currently detained on forensic section | 32 | 9 |
Of whom - Section 37 | 18 | 56 |
Of whom - Section 37/41 | 14 | 44 |
Risk history | ||
Assault on others more than 2 years ago | 96 | 28 |
Assault on others within the last 2 years | 68 | 20 |
Serious assault more than 2 years ago | 20 (4 homicides) | 5 |
Serious assault in last 2 years | 4 | 1 |
Sexual offence more than 2 years ago | 17 | 5 |
Sexual offence in the last 2 years | 3 | 1 |
History of fire setting more than 2 years ago | 15 | 4 |
History of fire setting in the last 2 years | 10 | 3 |
Overdose or self-harm more than 2 years ago | 83 | 24 |
Overdose or self-harm in the last 2 years | 58 | 17 |
Recurrent self-harm in the last 2 years | 21 | 6 |
Self-neglect in the last 2 years | 220 | 65 |
Function | ||
Mean Global Assessment of Functioning rating | 53 | (8) |
Mean Life Skills Profile rating | 128 | (15) |
Mean Time Use Diary (activity) rating | 49 | (11) |
Challenging behaviours | ||
Special Problems Rating Scale median (IQR) | 0 | (0, 2) |
Problematic alcohol use | 24 | 7 |
Problematic substance misuse | 15 | 4 |
Baseline | Follow up | |||
---|---|---|---|---|
n or median | % or (IQR) | n or median | % or (IQR) | |
Unit location | ||||
Inner city | 5 | 10 | ||
Suburbs | 43 | 86 | ||
Rural area | 2 | 4 | ||
Unit type | ||||
Hospital ward | 6 | 12 | ||
Community based | 44 | 88 | ||
Mean (SD) Mental Illness Needs Index score for local area of unit | 1.09 | (0.36) | ||
Staffing | ||||
Psychiatrist works in the unit | 47 | 94 | 50 | 100 |
Access to a psychiatrist | 3 | 6 | 0 | 0 |
Clinical psychologist works on the unit | 26 | 52 | 36 | 72 |
Access to a clinical psychologist | 20 | 40 | 11 | 22 |
Occupational therapist works on the unit | 39 | 78 | 41 | 82 |
Access to an occupational therapist | 7 | 14 | 6 | 12 |
Nurse works on the unit | 50 | 100 | 50 | 100 |
Support worker works on the unit | 50 | 100 | 50 | 100 |
Social worker works on the unit | 1 | 2 | 2 | 4 |
Access to a social worker | 39 | 78 | 45 | 90 |
Ex-service user(s) work in the unit | 19 | 38 | 20 | 40 |
Ex-service user(s) on the payroll | 15 | 79 | 17 | 85 |
Staff turnover | 14 | (8, 21) | 9 | (4, 17) |
Staff: service user ratio | 1.8 | (1.6, 2.2) | 1.9 | (1.8, 2.3) |
Beds | ||||
Beds on the unit | 13 | (10, 16) | 13 | (10, 16) |
% beds occupied | 95 | (89, 100) | 94 | (86, 100) |
Turnover | ||||
% staff turnover last 12 months | 14 | (8, 21) | 9 | (4, 17) |
% service user turnover last 12 months | 82 | (55, 113) | 92 | (56, 120) |
Interventions | ||||
Percentage taking clozapine | 37 | (25, 45) | 39 | (25, 45) |
Percentage taking multiple antipsychotics | 0 | (0, 0) | 0 | (0, 0) |
Percentage of service users with carer involvement | 76 | (64, 90) | 75 | (56, 87) |
Percentage of service users who had family intervention in the last year | 7 | (0, 28) | 7 | (0, 25) |
Percentage who received CBT in the last 12 months | 13 | (0, 33) | 9 | (0, 38) |
Unit manager “very happy” for their friend/relative to receive care on unit | 28 | 56 | 27 | 54 |
mean | (SD) | mean | (SD) | |
QuIRC domain scores (%) | ||||
Living environment | 79 | (7) | 79 | (7) |
Therapeutic environment | 68 | (6) | 71 | (5) |
Treatments and interventions | 65 | (7) | 65 | (8) |
Self-management and autonomy | 75 | (6) | 77 | (7) |
Human rights | 77 | (8) | 80 | (6) |
Recovery based practice | 72 | (7) | 74 | (7) |
Social inclusion | 65 | (12) | 65 | (11) |
Baseline | 12 month follow-up | |||
---|---|---|---|---|
mean | (SD) | n or mean | % or (SD) | |
Discharged from the rehabilitation unit | 219 | 66 | ||
Ready to be discharged from the rehabilitation unit | 48 | 14 | ||
Successfully discharged from the rehabilitation unit (n = 339) | 187 | 56 | ||
Successfully discharged or ready to be discharged from the rehabilitation unit | 235 | 71 | ||
Length of admission (months) median (IQR) | 18 | (9, 38) | 24 | (15, 48) |
Length of admission in the rehabilitation unit (months) median (IQR) | 7 | (3, 15) | 16 | (10, 23) |
Life Skills Profile score | 128 | (15) | 132 | (15) |
Global Assessment of Functioning score | 53 | (8) | 56 | (9) |
Time Use Diary (activity) score | 49 | (11) | 51 | (15) |
Adjusteda
| Unadjusted | |||
---|---|---|---|---|
QuIRC domain | Coefficient or odds ratio | 95 % confidence interval | Coefficient or odds ratio | 95 % confidence interval |
Life skills profile | ||||
Living environment | −0.02 | (-0.31, 0.27) | 0.11 | (-0.16, 0.38) |
Therapeutic environment | −0.06 | (-0.41, 0.28) | −0.11 | (-0.43, 0.21) |
Treatments and interventions | −0.18 | (-0.45, 0.08) | −0.20 | (-0.45, 0.04) |
Self-management and autonomy | −0.03 | (-0.34, 0.27) | 0.10 | (-0.19, 0.38) |
Human rights | −0.05 | (-0.30, 0.21) | 0.03 | (-0.21, 0.27) |
Recovery based practice | −0.09 | (-0.38, 0.20) | −0.04 | (-0.32, 0.24) |
Social inclusion | −0.06 | (-0.23, 0.11) | −0.06 | (-0.22, 0.09) |
Loge length of admission (rehab unit) | ||||
Living environment | 0.001 | (-0.006, 0.009) | 0.005 | (-0.014, 0.024) |
Therapeutic environment | 0.004 | (-0.004, 0.013) | −0.010 | (-0.032, 0.013) |
Treatments and interventions | 0.001 | (-0.006, 0.008) | −0.003 | (-0.021, 0.014) |
Self-management and autonomy | 0.003 | (-0.004, 0.010) | −0.001 | (-0.021, 0.019) |
Human rights | 0.005 | (-0.002, 0.011) | 0.001 | (-0.016, 0.018) |
Recovery based practice | −0.000 | (-0.007, 0.007) | −0.014 | (-0.033, 0.005) |
Social inclusion | 0.001 | (-0.003, 0.005) | −0.003 | (-0.014, 0.008) |
Odds ratio | 95 % confidence interval | |
---|---|---|
Length of current admission (months) | 0.99 | (0.99, 1.00) |
Life Skills Profile communication subscale score | 1.13 | (1.04, 1.24) |
Time Use Diary (activity) score | 1.03 | (1.01, 1.05) |
QuIRC Recovery Based Practice domain score (%) | 1.04 | (1.00, 1.08) |
% service users in the unit who received CBT in the year before recruitment | 0.99 | (0.98, 1.00) |
Odds ratio | 95 % confidence interval | |
---|---|---|
Any history of fire setting | 0.35 | (0.13, 0.92) |
Any self-harm | 2.02 | (1.16, 3.51) |
Length of current admission | 0.99 | (0.99, 1.00) |
Time Use Diary (activity) score | 1.05 | (1.02, 1.07) |
Baseline | Follow-up | |||||
---|---|---|---|---|---|---|
Service | % using service | Mean (SE) contactsb
| Mean (SE) cost (£s) | % using service | Mean (SE) contactsb
| Mean (SE) cost (£s) |
Psychiatrist | 97 | 2.1 (0.1) | 245 (9) | 66 | 1.7 (0.1) | 134 (9) |
Other medical specialist | 44 | 2.9 (0.1) | 135 (10) | 25 | 2.3 (0.2) | 61 (8) |
Clinical Psychologist | 19 | 3.2 (0.2) | 36 (5) | 11 | 2.4 (0.3) | 15 (3) |
Occupational Therapist | 57 | 7.9 (0.4) | 31 (2) | 23 | 6.2 (0.7) | 11 (1) |
Social Worker | 7 | 1.8 (0.3) | 15 (4) | 10 | 1.8 (0.2) | 21 (4) |
Counsellor/psychotherapist | 0 | 4 (.) | 1 (1) | 1 | 7 (1) | 2 (2) |
Volunteer | 8 | 4.1 (0.6) | 2 (0) | 2 | 3.3 (0.4) | 0 (0) |
Art/music/dance therapist | 2 | 3.8 (0.7) | 1 (0) | 2 | 3.5 (0.4) | 1 (1) |
Care coordinator | 45 | 2.3 (0.1) | 27 (2) | 62 | 2.8 (0.2) | 44 (4) |
Advocate | 2 | 2.1 (0.5) | 1 (0) | 1 | 1.2 (0.4) | 4 (1) |
Probation officer | 1 | 2.5 (1.5) | 2 (1) | 0 | 4 (.) | 1 (1) |
Other | 12 | 3.5 (0.5) | 24 (7) | 6 | 4.7 (1.2) | 14 (6) |
Nursea
| 99 | 16.4 (0.6) | 1216 (46) | 90 | 9.2 (0.6) | 678 (47) |
Support workera
| 64 | 11.8 (0.9) | 204 (13) | 63 | 22.7(2.7) | 241 (16) |
Total cost | 1938 (56) | 1229 (66) |
Baseline costs (N = 351) | Follow-up costs (N = 326) | |||||
---|---|---|---|---|---|---|
Variable | Coefficient | SE | 95 % CI | Coefficient | SE | 95 % CI |
Male | −280.3 | 126.7 | (-528.6, -32) | −206.8 | 166.4 | (-532.9, 119.3) |
White | −423.4 | 209.7 | (-834.3, -12.4) | 312.9 | 276.2 | (-228.4, 854.3) |
GAF score | −15.7 | 8 | (-31.4, -0.1) | −31.1 | 13.5 | (-57.6, -4.6) |
Age | 2.4 | 4.8 | (-7.1, 11.9) | 2.6 | 7.4 | (-11.9, 17.1) |
Type D behaviours (SPRS) | 188.4 | 91.7 | (8.7, 368.2) | 133.7 | 122.7 | (-106.8, 374.3) |
Type A behaviours (SPRS) | 154.9 | 122.5 | (-85.2, 395.1) | 329.9 | 168.6 | (-0.6, 660.4) |
Involuntarily admitted | 38.5 | 134.8 | (-225.7, 302.6) | 40.5 | 165.1 | (-283.1, 364.1) |
Baseline cost | 0 | 0.1 | (-0.1, 0.2) | |||
Constant | 3156.6 | 608.8 | (1963.3, 4349.9) | 2607.5 | 914.1 | (815.8, 4399.2) |