Academic journal article Australian Health Review

Type of Housing Predicts Rate of Readmission to Hospital but Not Length of Stay in People with Schizophrenia on the Gold Coast in Queensland

Academic journal article Australian Health Review

Type of Housing Predicts Rate of Readmission to Hospital but Not Length of Stay in People with Schizophrenia on the Gold Coast in Queensland

Article excerpt

ABSTRACT

Accommodation is considered to be important by institutions interested in mental health care both in Australia and internationally. Some authorities assert that no component of a community mental health system is more important than decent affordable housing. Unfortunately there has been little research in Australia into the consequences of discharging people with a primary diagnosis of schizophrenia to different types of accommodation. This paper uses archival data to investigate the outcomes for people with schizophrenia discharged to two types of accommodation. The types of accommodation chosen are the persons own home and for-profit boarding house. These two were chosen because the literature suggests that they are respectively the most and least desirable types of accommodation. Results suggest that people with schizophrenia who were discharged to boarding houses are significantly more likely to be readmitted to the psychiatric unit of Gold Coast Hospital, although their length of stay in hospital is not significantly different.

Key Words

Housing, schizophrenia, admission rates, boarding house.

INTRODUCTION

According to the National Mental Health Strategy (1994a), housing is considered the most crucial community support service needed for the success oi the policy of deinstitutionalisation. There is substantial support for this view in Australia (Burdekin et al. 1993, Mental Health Strategy for Queensland 1996, The National Mental Health Strategy 1992) and internationally (World Health Organization 1990). This view is also well supported by research (Anthony & Blanch 1989, Baker & Douglas 1990, Posey 1990, Rosenfield 1990, Stroul 1989).

In spite of this and other evidence, housing for people with mental health problems is often of a poor standard (Burdekin et al. 1993) and there is a view that decision makers in mental health services do not take the issue of housing seriously (Quinn 1988, 1994).

Impact of housing on admissions and wellbeing

A two-year longitudinal study by Kirkpatrick et al. (1996) confirms that living outside institutions is the best place for people with schizophrenia. Participants had a history of schizophrenia and of prolonged or repeated treatment in a psychiatric hospital and a history of unsuccessful community functioning. Results demonstrated that quality of life and level of global functioning improved the longer the participants were out of hospital.

In the US, a study of 69 chronic psychiatric patients in two communities examined the relative contribution of housing versus psychiatric services to hospital readmission based on data on the use of mental health services, housing and financial assistance collected from patients' hospital records (Rosenfield 1990). Services for housing were a better predictor of success (that is, of not being hospitalised) than the existence of a mental health service, and the author concluded that housing services have a critical effect on relapse (Rosenfield 1990).

A much larger study (Baker & Douglas 1990) of 729 deinstitutionalised severely mentally ill people in New York state found a causal relationship between the quality of housing and global functioning and quality of life (QoL). That is, participants who remained in adequate and appropriate housing (as assessed by case managers) improved, and those in poor housing remained the same or deteriorated in their level of functioning. Participants who moved from poor quality housing to better housing improved in their global functioning; and vice versa - participants who moved from good to poor quality housing deteriorated in their global levels of functioning and their perceived QoL. The study concluded that quality of housing can impact significantly on the community adjustment outcomes of consumers (Baker and Douglas 1990).

Consumer Preferences and Housing Types

There is evidence that consumers of mental health services have a strong preference for normal living situations. …

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