To “take over” or “to take on”
challenges concerning hospitalization of long term mental health care
Background
• Mental health care budget cuts
• Transition in society: focus on self sustainability
• Residential service users with severe mental illness into the community
Supported housing Independent living situation
Introduction
• Quantative study: service users
• Conference with policy officers from the
participating Regional Institutes for Residential Care (RIRC’s; n=3)
-> How do key workers and managers view and experience deinstitutionalisation?
Do they think it’s realistic, possible and under what constraints How are we doing? What are we doing?
Objective
Explore the way managers and key workers
perceive possibilities and problems that
accompany the transition of service users with severe mental illness (SMI) from supported
housing towards independent living with(out) support.
Participants
3 Regional Institutes for Residential Care (RIRC) Arnhem, Brabant, Den Haag
• 4 managers
• 6 key workers, trained in rehabilitation oriented care
Method
• Semi structured interviews
• Opinion about deinstitutionalization
• How they?? support service users/ key workers in working towards independence
• Support of RIRC towards…??
• What helping and hindering factors do RIRC’s/key workers/ service users ? encounter in this process
• Cooperation with local partners
• Niet beginnen met how…. Gewoon puntsgewijs onderwerp van he vraag benoemen zoals in de laatste zin, dat is het meest kort.
• En wie zijn ‘they’ in de tweede zin?
Results
• All respondents expect a large group of service users to be able to move towards independent living with(out) support
“they can probably do more than they’re expecte
d to now”
“Currently, we might take care of them more than what
is actually needed”
“I only talk about working towards independent living with service users that express this wish themselves”
Results
• Respondents recognise hospitalization:
– Service users (n=10): “loosing initiative and skills”, “leaning backward”, “self stigmatisation and low self confidence”
– Key workers(n=9): “knowing best”, “taking over”, “focussing too much on living skills instead of the individual recovery process”, “underestimating”
Hospitalisation
“You can stay here for the rest of your life” Key workers support and care
Too much care causes service users to become dependent and loose initiative
key workers observe this dependency and increase care provision
Examples
“If they were able to live independently, they would have done so already”
“H. always cooked his own meals before moving to supported housing. Now, a hostess prepares the meals, and H. is fine with that.”
“P. collects stamps and told us that he worked at a stamp-shop.
We (key workers) didn’t believe him untill we saw it with our own eyes.”
Self-fulfilling prophecy
Loosing skills
Discussion
• Different statements at the beginning and end of the interviews (n=4)
• Even with rehabilitation oriented care training it is difficult to stay out of the vicious cycle
• Occupational hazard? (Choosing this profession and adapting to organisational standard)
Future
• Learning to support instead of ‘take care of’
– Tools and skills
• Expectancy management
– Supported housing is a temporary situation
• New interventions like
– Structured goal setting and working towards goals
– Regular evaluation of goal achievement
