Mayview Discharge Study University of Pittsburgh

The Pitt Study Goals of this presentation – Recap findings – Identify and focus on potential areas for improvement

Methods 65 people (75% of a random sample) participated in a two-year follow up study of: – Standardized assessments of major indicators of quality of life and recovery – Qualitative observations and interviews We met with people every three months – participants at each time point 225 standardized assessments and 138 “check-ins” over two years

Major qualitative findings Participants like their new residences and were comfortable with the discharge process With new-found freedom, a few people get in trouble Many people have staff as their primary contacts, and some find their lives rather monotonous Housing is an on-going concern

People are satisfied with their new residences New residences are preferred to the hospital – No comparison. It’s better. It’s the freedom factor – I’m free. I go more places. I do what I want to do. People feel safe and comfortable – Here, I am much more relaxed – I am much more comfortable – There are less people. If residents don’t get along, it gets taken care of by staff

Potential perils of freedom A small number of people became re-involved with criminal activity, usually illegal substance use, and experienced negative consequences

Progress needed on community integration Many participants would welcome more varied activities – Q: What do you do? A: Sleep. Get up and watch TV. Come out here and smoke. – Q: What is there to do? A: Sleeping. Groups. That’s about all. – I don’t go anywhere. I don’t have any money. Some participants are very active – I am in the process of getting prepared to get a job. I’ll see what kinds of things I want to do.

Staff are often the primary social contacts Many people report that they depend mostly on staff – No one has visited me besides my peer mentor and CTT – My case manager is my best friend, guardian, big sister. I have 24-hour access to her. – I can talk to CTT any time if there’s something going on or I need them to advocate for me

Housing is a continuing concern Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic Most participants are poor, and will rely on public housing as they become more independent – Public housing is not always available – When available, the quality and safety of public housing is variable

Major quantitative findings Psychiatric symptoms go down over time – 50% of people meet a recently published criterion for symptom remission at the 2-year time point Contact with friends and social adjustment go up over time No quantitative indicator deteriorated over time

Average BPRS score over time

Percent with at least moderate illness (BPRS >41)

Criteria for remission Remission of BRPS-rated psychotic symptoms – Seven symptoms related to psychosis Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect – Rated 3 (mild) or less for six months Additional criterion: – Overall BPRS < 31 for six months 50 participants had at least two standardized assessments in Year 2 of the study – We examined their last two observations

Remission 30 of 50 (60%) were in remission from psychotic symptoms 24 of 50 (48%) were in remission and also had low overall BPRS scores

See friends regularly (percent)

How do participants compare to other groups? Quality of life and Progress towards Recovery – Did not change over time – Compared favorably to other populations for whom data have been published Perceptions of Care – Did not change over time – Were somewhat lower than the major published benchmark

Quality of Life – all scales (by scale)

WHOQOL: Mayview contrasted with other samples (by sample)

WHOQol compared to other samples

Recovery Assessment Scale– all subscales (by subscale)

RAS: Mayview contrasted to Australian sample of MH consumers

RAS: Mayview in contrast to Australian MH consumers

Perceptions of Care– all scales (by scale)

POC: Mayview contrasted with JCHO sample

Would you recommend this facility?

Rate services from 1-10 (percent)

Omitting the 25-30% who choose ‘10’

Rate services from 1 to 10 (percent)

Conclusions The closing was successful Possible areas for continued discussion are: – How to bring variety and community integration into people’s lives – Housing Is there enough Can it be stable, supportive, and recovery-oriented – Perceptions are care Can satisfaction with providers be improved

“The best experience has been knowing that I can make it in the real world. Not as hard as I projected it to be.”