Summary

In Canada, only heart disease surpasses mental illnesses in hospitalization costs. Mental health care reform will decrease the number of psychiatric beds in demand, and increase the number of clients served in the community. The use of appropriate models of discharge planning, and community integration will be critical for success. There is, however, very little research about this topic.

This four-year, $930,000 study tested a new approach to supporting people with chronic mental illness who make the transition from the hospital to the community. It involved 380 discharged patients from Regional Mental Health Care London/St. Thomas (formally known as London/St. Thomas Psychiatric Hospital), the Centre for Mountain Health Care, St. Joseph's Health Care, Hamilton (formally known as Hamilton Psychiatric Hospital) and the Whitby Mental Health Centre.

The overall objective of this study was to assist individuals who were hospitalized with a chronic mental illness in successful community living. The specific objectives were to determine the cost and effectiveness of a transitional discharge model of care, and compare it to the standard model of discharge. The transitional model focused on interpersonal relationships. This new model included:

(a) peer support, which involved assistance from former clients of the mental health care system who promoted friendship, provided understanding, taught community living skills, and encouraged current clients in making a transition from psychiatric hospital to community, and

(b) overlap of in-patient and community staff in which the in-patient staff continued to treat clients until the clients had working relationship with a community care provider.

The Mental Health Rights Coalition of Hamilton and Can-Voice of London worked with the project to develop a training program for peers. This included a generic training manual. At the time, sixteen consumer groups were partnered with the project to provide the peer support.

Outcome measures included quality of life and costs. It was hypothesized that, in the year following discharge from a psychiatric hospital, individuals participating in the transitional discharge model would:

(a) have an improved quality of life; and

(b) incur fewer health and social services costs compared to individuals receiving standard discharge care.