Academic journal article The Israel Journal of Psychiatry and Related Sciences

Do Persons with Severe Mental Illness Who Consume the Psychiatric Rehabilitation Basket of Services in Israel Have Better Outcomes Than Those Who Do Not?

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Do Persons with Severe Mental Illness Who Consume the Psychiatric Rehabilitation Basket of Services in Israel Have Better Outcomes Than Those Who Do Not?

Article excerpt

ABSTRACT

Background: Since the implementation of the legislation of the Rehabilitation of the Mentally Disabled in the Community Law a decade ago, an increasing number of people have been receiving the psychiatric rehabilitation "basket of services," yet the impact of these services has barely been studied. The purpose of the present study is to examine whether people with severe mental illness in Israel who consume psychiatric rehabilitation services report better outcomes than people with severe mental illness who are eligible and have applied for psychiatric rehabilitation services but have not yet utilized them.

Method: 1,191 persons with severe mental illness (595 psychiatric rehabilitation service users and 596 non-users) completed face-to-face interviews. Differences in quality of life, general satisfaction and psychiatric symptoms between psychiatric rehabilitation service users and non-users were examined using Analysis of Covariance controlling for the potential confounding effects of age and marital status.

Results: Adjusted comparisons of quality of life, general satisfaction and psychiatric symptoms revealed that psychiatric rehabilitation service users had better outcomes than non-users: they reported better quality of life and greater satisfaction alongside fewer psychiatric symptoms. The most striking difference between the groups was found in the domain of employment and income, with non-psychiatric rehabilitation service users scoring 0.9 effect sizes below psychiatric rehabilitation service users.

Conclusion: The current study, based on a relatively large sample, provides support for the effectiveness of the psychiatric rehabilitation "basket of services." Future studies including clinicians' ratings of more objective aspects of functioning may provide a broader picture of the association between psychiatric rehabilitation service utilization and outcome.

INTRODUCTION

The rapid development of psychiatric rehabilitation over the last two decades has affected services in several countries (1) including Israel (2). Psychiatric rehabilitation refers to adapting and applying rehabilitation principles and practices used with a variety of disabilities to help clients cope and recover from severe mental illness (SMI) (3). Since the implementation of the legislation of the Rehabilitation of the Mentally Disabled in the Community Law (RMD) a decade ago (4), an increasing number, currently estimated at nearly 16,000 people, have been receiving the psychiatric rehabilitation "basket of services" (2). The "basket of services" attempts to address the key disadvantages consumers often face by providing them with services that focus on building skills and supports in domains such as work, recreation, education, social life and housing to improve their opportunity to pursue valued social roles in the community. For example, residential services consist of flexible and need tailored support to persons living in rented and sheltered apartment as well as hostels. Vocational services include sheltered workshops and assistance in acquiring vocational skills and competitive employment. The services specified by the legislation had no explicit standards or criteria for selection, but rather were proposed on the basis of the available professional, clinical and personal experience at the time the legislation was prepared (5).

Recent efforts to address the general oversight of the mental health service system have generated a growing focus on watchwords such as "system quality," which focuses on the outcomes of interventions, and "accountability," which refers to the adherence to an intervention (6). Both approaches emphasize the importance of applying practices found to be effective across a variety of psychiatric rehabilitation and mental health systems through knowledge transfer, dissemination and integration (7). As a result, mental health services are now expected to be outcome-oriented and the assessment of client outcomes is becoming a more common aspect of mental health service provision (8). …

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