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.
About the Alcohol Research Group
The Alcohol Research Group at the Public Health Institute has conducted epidemiological studies of alcohol and health services research since 1959. The group is one of 18 National Alcohol Research Centers funded by the National Institute on Alcohol Abuse and Alcoholism.
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About the Public Health Institute
The Public Health Institute is one of the largest nonprofit organizations in the country dedicated to improving the public's health and quality of life in California, across the nation, and around the world. Our primary methods for achieving these goals include sharing evidence developed through quality research and evaluation, providing training and technical assistance, and promoting successful prevention strategies to policymakers, communities, and individuals.
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