Mayview discharge study
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Mayview Discharge Study. University of Pittsburgh. The Pitt Study. Goals of this presentation Recap findings Identify and focus on potential areas for improvement. Methods. 65 people (75% of a random sample) participated in a two-year follow up study of:

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Mayview Discharge Study

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Mayview Discharge Study

University of Pittsburgh


The Pitt Study

  • Goals of this presentation

    • Recap findings

    • Identify and focus on potential areas for improvement


Methods

  • 65 people (75% of a random sample) participated in a two-year follow up study of:

    • Standardized assessments of major indicators of quality of life and recovery

    • Qualitative observations and interviews

  • We met with people every three months

    • 45-50 participants at each time point

  • 225 standardized assessments and 138 “check-ins” over two years


Major qualitative findings

  • Participants like their new residences and were comfortable with the discharge process

  • With new-found freedom, a few people get in trouble

  • Many people have staff as their primary contacts, and some find their lives rather monotonous

  • Housing is an on-going concern


People are satisfied with theirnew residences

  • New residences are preferred to the hospital

    • No comparison. It’s better. It’s the freedom factor

    • I’m free. I go more places. I do what I want to do.

  • People feel safe and comfortable

    • Here, I am much more relaxed

    • I am much more comfortable

    • There are less people. If residents don’t get along, it gets taken care of by staff


Potential perils of freedom

  • A small number of people became re-involved with criminal activity, usually illegal substance use, and experienced negative consequences


Progress needed on community integration

  • Many participants would welcome more varied activities

    • Q: What do you do? A: Sleep. Get up and watch TV. Come out here and smoke.

    • Q: What is there to do? A: Sleeping. Groups. That’s about all.

    • I don’t go anywhere. I don’t have any money.

  • Some participants are very active

    • I am in the process of getting prepared to get a job. I’ll see what kinds of things I want to do.


Staff are often the primary social contacts

  • Many people report that they depend mostly on staff

    • No one has visited me besides my peer mentor and CTT

    • My case manager is my best friend, guardian, big sister. I have 24-hour access to her.

    • I can talk to CTT any time if there’s something going on or I need them to advocate for me


Housing is a continuing concern

  • Some people adjust well to supervised housing situations designed for short stays (e.g., CRRs), and find the need to relocate again problematic

  • Most participants are poor, and will rely on public housing as they become more independent

    • Public housing is not always available

    • When available, the quality and safety of public housing is variable


Major quantitative findings

  • Psychiatric symptoms go down over time

    • 50% of people meet a recently published criterion for symptom remission at the 2-year time point

  • Contact with friends and social adjustment go up over time

  • No quantitative indicator deteriorated over time


Average BPRS score over time


Percent with at least moderate illness(BPRS >41)


Criteria for remission

  • Remission of BRPS-rated psychotic symptoms

    • Seven symptoms related to psychosis

      • Grandiosity, suspiciousness, unusual thought content, hallucinations, conceptual disorganization, blunted affect

    • Rated 3 (mild) or less for six months

  • Additional criterion:

    • Overall BPRS < 31 for six months

  • 50 participants had at least two standardized assessments in Year 2 of the study

    • We examined their last two observations


Remission

  • 30 of 50 (60%) were in remission from psychotic symptoms

  • 24 of 50 (48%) were in remission and also had low overall BPRS scores


See friends regularly (percent)


How do participants compare to other groups?

  • Quality of life and Progress towards Recovery

    • Did not change over time

    • Compared favorably to other populations for whom data have been published

  • Perceptions of Care

    • Did not change over time

    • Were somewhat lower than the major published benchmark


Quality of Life – all scales (by scale)


WHOQOL: Mayview contrasted with other samples (by sample)


WHOQol compared to other samples


WHOQol compared to other samples


Recovery Assessment Scale– all subscales (by subscale)


RAS: Mayview contrasted to Australian sample of MH consumers


RAS: Mayview in contrast to Australian MH consumers


Perceptions of Care– all scales (by scale)


POC: Mayview contrasted with JCHO sample


Would you recommend this facility?


Rate services from 1-10 (percent)


Omitting the 25-30% who choose ‘10’


Rate services from 1 to 10 (percent)


Conclusions

  • The closing was successful

  • Possible areas for continued discussion are:

    • How to bring variety and community integration into people’s lives

    • Housing

      • Is there enough

      • Can it be stable, supportive, and recovery-oriented

    • Perceptions are care

      • Can satisfaction with providers be improved


  • “The best experience has been knowing that I can make it in the real world. Not as hard as I projected it to be.”


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