Was It a Good Move? Improvement in Quality of Life among Chronic Mental Patients Moving from a Mental Hospital to a Hostel in the Community/Discussion
Umansky, Roberto, Amir, Marianne, Fridmann, Monica, Zidon, Esther, et al., The Israel Journal of Psychiatry and Related Sciences
Abstract: Background. This study examined whether transition from hospital to hostel improves patients' quality of life (QOL). Method. In a longitudinal prospective study comparing the QOL of 16 patients who moved to a hostel with that of 20 who remained hospitalized, we posited that the former would exhibit improved QOL. We also assessed the reliability of psychiatric patients' reports by comparing them with staff reports. Results. No changes were reported in the QOL of hospitalized patients, whereas those who moved to the hostel exhibited significant improvement in all aspects of life, as reflected in the World Health Organizations Quality of Life measure (WHOQOL-BREF), reports by patients and staff and subjective (but not objective) indicators in the TL30s questionnaire. Patients' reports reflect a higher QOL improvement than staff reports but both display similar trends regarding changes in QOL. Conclusions. It was concluded that the move from the hospital to the hostel improved the QOL of the patients.
In the 1960s and 1970s, social scientists, philosophers and politicians began to display interest in concepts such as "quality of life" (QOL) and "standard of living" (1). Moreover, appreciation of welfare policies encouraged research on social indices and well being, particularly quality of work, family life and leisure (1). In medicine, increased popularity of the quality of life movement, with emphasis on the patient's subjective point of view, stemmed from consumers' increasing dissatisfaction with medical care. One specific aspect of this dissatisfaction was the feeling that, in an effort to extend life at any cost and exclusive focus on treatment needs, medicine tended to ignore the human needs of its patients, such as well-being, autonomy and a sense of belonging (1). Barry and Crosby (2) note that despite emphasis on QOL as a significant indicator of results in evaluating community treatment services, relatively few studies have examined the sensitivity of QOL indicators in evaluating change. Most QOL studies of people with chronic psychiatric disorders compared groups in various treatment programs. Prospective longitudinal studies, comparing situations of people before and after transfer from one type of program to another, will enable a more direct QOL comparison. The present study employs such research techniques.
Defining Quality of Life
QOL has not been defined uniformly to date. It may be perceived as a person's health and well-being, affected by the values and norms accepted in society, or, alternatively, as a person's need for functional system gratification: Normal development, health and the like (3). As QOL is a multi-factorial concept, studies must not relate to objective QOL variables alone. Personality characteristics and subjective perception exert a profound effect on QOL (4). It is generally agreed that QOL is of an essentially subjective nature. As such, most definitions account for physical health status, functional ability, psychological well-being, social interaction and economic status.
QOL of Psychiatric Patients
Society's treatment of the mentally ill over the past century - institutionalization in large mental hospitals - may be perceived as responding to basic human needs for physical satisfaction (such as food) and security (such as shelter), while neglecting higher human needs such as autonomy. On the other hand, by the end of the 20th century, in the era of community psychiatry, patients could achieve autonomy, possibly at the expense of forgoing attention to their more fundamental human needs met (1). Besides having additional needs specific to treatment, psychiatric patients are at a disadvantage because they lack resources for coping with life problems, social and cognitive skills and environmental resources, especially financial (1).
Over the past five decades, many chronic mental patients have been shifted from hospitals to community-based treatment in fulfillment of a national policy of deinstitutionalization. …