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A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems.

Taylor, TL; Killaspy, H; Wright, C; Turton, P; White, S; Kallert, TW; Schuster, M; Cervilla, JA; Brangier, P; Raboch, J; et al. Taylor, TL; Killaspy, H; Wright, C; Turton, P; White, S; Kallert, TW; Schuster, M; Cervilla, JA; Brangier, P; Raboch, J; Kalisová, L; Onchev, G; Dimitrov, H; Mezzina, R; Wolf, K; Wiersma, D; Visser, E; Kiejna, A; Piotrowski, P; Ploumpidis, D; Gonidakis, F; Caldas-de-Almeida, J; Cardoso, G; King, MB (2009) A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry, 9 (55). ISSN 1471-244X https://doi.org/10.1186/1471-244X-9-55
SGUL Authors: White, Sarah Jane Wright, Christine

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Abstract

BACKGROUND: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. METHODS: We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. RESULTS: We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). CONCLUSION: Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

Item Type: Article
Additional Information: © 2009 Taylor et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Clinical Governance, Community Mental Health Services, Guideline Adherence, Health Care Surveys, Humans, Institutionalization, Long-Term Care, Mental Disorders, Meta-Analysis as Topic, Outcome Assessment (Health Care), Quality Assurance, Health Care, Quality of Health Care, Rehabilitation, Vocational, Schizophrenia, Social Work, Psychiatric, Science & Technology, Life Sciences & Biomedicine, Psychiatry, PSYCHIATRY, SCI, RANDOMIZED CONTROLLED-TRIAL, CHRONIC PSYCHIATRIC GROUP, SUPPORTED EMPLOYMENT, THERAPEUTIC ALLIANCE, RESIDENTIAL CARE, COMMUNITY CARE, OF-LIFE, PSYCHOLOGICAL TREATMENTS, NEUROCOGNITIVE DEFICITS, PSYCHOSOCIAL TREATMENT, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BMC Psychiatry
ISSN: 1471-244X
Language: eng
Dates:
DateEvent
7 September 2009Published
PubMed ID: 19735562
Web of Science ID: WOS:000270714900001
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/107323
Publisher's version: https://doi.org/10.1186/1471-244X-9-55

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