Abstract：
:Psychiatric rehabilitation (PR) is widely recognized as a treatment approach and an array of evidence-based practices effective for promoting the recovery of people with serious mental illness (SMI). However, its use in institutional settings is not widespread for unclear reasons. Policymakers may sometimes believe the superiority of PR in controlled research does not apply in the real world, for various reasons. This study exploits an unusual set of real-world circumstances surrounding the closure of a well-developed PR program in a state hospital. The program was closed after a period of mental-health services reform that significantly augmented the surrounding community-service system. The PR program was converted to conventional medical-institutional model-treatment units with no reduction in beds or funding within the state hospital. A database composed of public documents was used to analyze the consequences of the closing. Within the institution, the consequences included a persistent presence of long-term difficult-to-discharge patients, a slowed discharge rate, a net increase in the hospital's per capita treatment costs, and higher use of restraint/seclusion. Effects were also detectable in the surrounding mental-health service system, including degraded outcome of community-based step-down services and increased pressure on emergency/crisis services. The consequences of closing the program are consistent with expectations based on research, and demonstrate danger in assuming that real world exigencies obviate research findings.
journal_name
Psychol Servjournal_title
Psychological servicesauthors
Tarasenko M,Sullivan M,Ritchie AJ,Spaulding WDdoi
10.1037/a0030260subject
Has Abstractpub_date
2013-11-01 00:00:00pages
442-51issue
4eissn
1541-1559issn
1939-148Xpii
2012-30023-001journal_volume
10pub_type
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