Residential Facilities as the New Scenario of Long-Term Psychiatric Care

Giovanni de Girolamo; Mariano Bassi

Disclosures

Curr Opin Psychiatry. 2004;17(4) 

In This Article

Conclusion

This nonsystematic review has several limitations. First, it covers a limited period, and therefore many important contributions to the field, which were published earlier, have not been included. Second, important databases which may contain information relevant to the field (e.g. Psychinfo) have not been considered. Despite these limitations, a review of the most recent literature has helped identify at least some of the most relevant problems in the field of residential care, which we will briefly summarize now.

  1. Probably the main point of controversy is to clearly define the role of residential facilities, that is whether they should be conceptualized as intensive treatment programmes, or merely as ordinary homes or living settings for people who participate fully in treatment and psychosocial programmes provided by local mental health services. These contrasting objectives may actually lead to different characteristics of their functioning and to diverse typologies of care processes, although the scientific literature usually refers to residential facilities as a unitary concept.

  2. Related to this point, there is the need to develop a clear taxonomy of residential facilities, based on specific operational criteria. This taxonomy should spell out acceptable ranges of available residential facilities, staffing levels, optimal size, satisfactory environmental features and activities needed to fill residents' weekly time, and in particular weekends, evenings, and so on.

  3. Precise patients' inclusion criteria should be developed; all patients that are candidates for residential facility admission should receive careful, multidimensional assessments, highlighting not only clinical characteristics but also impairments in social and vocational roles. Management plans and related organizational frameworks should match residents' typologies and their various needs and requests. Patients' rehabilitation plans should be carefully monitored with appropriate instruments. Avoiding an indistinct case mix (i.e. aged patients mixed up with young, treatment-resistant patients) in residential facilities is a prerequisite for the development of tailored treatment plans and for transforming residential facilities into effective rehabilitation settings for those patients with realistic prospects of rehabilitation. This strategy also implies the selection of staff with specific characteristics, and a reasonable staff turnover should be foreseen to prevent burnout.

  4. Specific facilities, management plans and trained staff should be available for the residential treatment of specific patient populations, in particular patients at high risk of violence, with dual diagnoses and with severe personality disorders (and all these conditions are often associated).

  5. Finally, outcome research should refrain from generic questions (e.g. 'Does residential care work?') and should address specific questions, such as 'What kind of residential care appears to be most effective for what kinds of residents by what type of outcomes and in what kind of social and service context?' (Shepherd, personal communication).

Addressing these important points in research and clinical practice will enable the whole field of residential care to progress so that it can respond to the complexities of modern mental health care.

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