Care pathways, engagement and outcomes associated with a recovery-oriented intermediate stay mental health program. (April 2020)

• Record Type: Journal Article
• Authors: Sly, Ketrina A.; Lewin, Terry J.; Frost, Barry G.; Tirupati, Srinivasan; Turrell, Megan; Conrad, Agatha M.
• Is Part Of: Psychiatry research. Volume 286(2020)
• Publication Date: 2020-04
• Subjects: Mental health services -- Inpatient -- Sub-acute -- Health service utilization -- Psychiatric rehabilitation -- Recovery Star -- Clinical outcomes; ISMHU Intermediate Stay Mental Health Unit -- MHS Mental Health Services -- MH Mental Health -- LOS Length of Stay -- SMI Serious Mental Illness -- NGO Non-Government organization -- NSW New South Wales -- HNE-LHD Hunter New England Local Health District -- CBMHR Centre for Brain and Mental Health Research -- IRM Integrated Recovery-oriented Model -- IPMS Inpatient Management System -- CID Clinical Information Department -- MHRS Mental Health Recovery Star -- HoNOS Health of the Nation Outcome Scale -- CHIME Clinical Information and Management Exchange; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2020.112889
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Community referrals potentially avoided an acute MH admission or subsequent transfer. Program engagement & recovery domain improvements occurred across arrival categories. Clinical improvement was rated higher for community & involuntary inpatient referrals. Arrival category was associated with service patterns & the strongest outcome predictor. Community referrals had the largest reduction in MH admissions & community contacts. Abstract: This study examined care pathways, program engagement, and key outcomes associated with a sub-acute inpatient stay in a 20-bed stand-alone Intermediate Stay Mental Health Unit (ISMHU; NSW, Australia). A 6-week evidenced-based tailored intervention program was offered, utilizing a recovery-oriented model of care. Service data from multiple record systems were combined, including admissions and service contacts 2-years prior to and following the index admission. During the initial 16-months there were 146 index admissions with a length of stay greater than 7 days. The majority (75.3%) were transfers from acute-care, with an average ISMHU stay of 50.3 days. Service and clinical outcomes were examined in relation to care pathways, recovery needs, program engagement and benefits achieved. Substantial engagement was detected (e.g., 74.0% >10 intervention types), together with significant improvements on self-report and clinician rated measures (e.g., social connection, symptoms, and self-belief). Logistic regression analyses revealed that arrival category was the strongest outcome predictor, with community referrals experiencing the largest reduction in subsequent acute mental health admissions (58.3% to 16.7%), followed by involuntary inpatient referrals (80.3% to 60.7%). Potential recovery-focused benefits are not limited to community treatment settings, while pathways to care may help identify clients with differing needs and opportunities for treatment.