Eleventh International Conference of the European Network For Mental Health Service Evaluation

Deinstitutionalisation, social

inclusion & personal recovery

Charlotte de Heer-Wunderink, Ingrid van der Zee & Sandra Vos Hanze University of Applied Sciences

Content

• Deinstitutionalisation in the Netherlands

• The MOVE-project

• Social inclusion, recovery and self

sustainability

Transitions in mental health care

– Financial: large budget cuts

– Ideological: from caring for to

supporting/promoting

• Personal recovery • Self efficacy

Challenges

Residential care for people with severe mental

illness

 Insufficient implementation of recovery oriented care

 Crises and ‘daily hassles’ tend to take over

 Lack of training of professionals in evidence based practices: skills, knowledge and attitude

 Hospitalisation of staff as well as service users

The MOVE-project

• Longitudinal follow-up study

– 2 years

– 129 service users + key workers

• 6 RegionaI Institutes for Residential Care

• Monitoring deinstitutionalisation

– From community residential care to independent living

This presentation

• 1 year follow up

– Who has made the transition to independent living?

– What is key to that transition? Social inclusion

Personal recovery Self sustainability

Methods

Survey (interview): social inclusion:

vocational participation

social relations: number and nature leisure activities

personal recovery:

Mental Health Recovery Measure (MHRM; official Dutch translation)

Analysis

• SPSS 20 and Statistica

• Descriptives, Chi square, logistic regression,

ANOVA and feature selection analysis

• Aims:

– establish differences between service user groups – identify predictors for independent living

MOVE: service user participants

Participants:

wish for independent living at T1  living situation at T3 n=129 33 % (n=42) 48 % (n=62) 59 % (n=76) 19 % (n =25) 41 % (n= 53) n=3 n=11 n=3 T1 T3

Socio-demographic &

clinical characteristics

RC no wish*

(n=42) RC wish*(n=62) (n=25)IL* test

Male, % (n) 86 (36) 68 (42) 68 (17) Age mean, (sd) 48 (9) 40 (13) 39 (14) F=7, df=2, p<.01 Care 0-4 years 4-8 years > 8 years 13 (5) 23 (9) 64 (25) 50 (29) 29 (17) 21 (12) 44 (11) 36 (9) 20 (5) χ2=25, df=2, p<.01 schizophrenia, % (n) 54 (22) 36 (21) 41 (9) addiction yes, % (n) 17 (7) 38 (23) 24 (6)

Social Inclusion

Social inclusion

• Vocational participation:

– No significant differences between groups after 1 year

• Social relations

– Residents no wish for independent living < residents with a wish and independently living services users at T1 and T3 (F (2,126)= 4.5,

p<.05)

• Leisure activities

– Residents no wish: more activities with other residents and staff compared to other service users (χ2=12.3 and 13.3, df=2, p<.01)

• The number of social relations is a predictor for independent

living at T1 and through time (feature selection: χ2=17.9, p<.05; χ2=52.6,

Personal recovery

• Mental Health Recovery Measure (Young & Bullock, 2003; Dutch version: Moradi, Brouwers, Van den Boogaard & Van Nieuwenhuizen, 2007)

Reliability: Cronbachs α: 0.86-0.94 Acceptable construct validity

30 statements

Likert scale: strongly disagree (1) - strongly agree (5)

‘I’m worthwhile, despite my psychological problems’ ‘My way of thinking, helps me to achieve my goals’

MHRM: Personal recovery

Developments between T1 - T3

MHRM: Personal recovery

Developments between T1 - T3

Independently living service users

Social contacts Way of thinking

Personal recovery

Residential service users without a wish = laggards concerning:

belief in a better future (χ2=40, p<.001)

working hard on psychological recovery (χ2=25, p<.001)

taking risks for personal recovery (χ2=32, p<.001)

belief in oneself (χ2=19, p<.05)

postive growth and changes (χ2=22, p<.01)

social contacts/friends (χ2=18, p<.05)

Self sustainability

• Residential service users without

a wish have/experience less

social skills wellbeing

(knowledge of possible) support motivation

Summary

Residential service users without a wish are

lagging

motivation/wish = important for transition

social relations: the more the better

personal recovery does matter