Continuing Accommodation and Support Needs of Long-Term Patients with Severe Mental Illness in the Era of Community Care

Background: The accommodation and support needs of former long-stay and “new” long-stay patients with severe mental illness are complex. These two groups with different histories but similar needs are referred to in this paper as long-term patients. The science of psychiatric rehabilitation has advanced, but residential instability, homelessness, forensic involvement and substance abuse contribute to the rehabilitation challenges for long-term patients. Methods: This paper reviews recent evidence concerning outcomes of community mental health care for long-term patients. It reviews models of residential rehabilitation and residential care and the application of recovery principles to them. Results: Long-term patients continue to experience unstable accommodation, isolation, poor quality of life and are vulnerable to reinstitutionalisation. Their varied needs can be met effectively, but are frequently not met in a sustained way. Positive outcomes are associated with provision of choices in small-scale accommodation services that are linked with assertive outreach from specialist mental health teams and integrated with existing community services. Conclusions: Providing the accommodation and care needed by long-term patients to support recovery and effective rehabilitation requires analysis of the determinants of outcomes for patients in residential and non-residential settings. Particular attention is needed to continuing enhanced community mental health care, treatment of concurrent substance use and access to a range of residential support services for as long as necessary. For a small but important minority of patients there is a need to continue these arrangements indefinitely. Research on the essential ingredients of effective models of care, including consumer perspectives, is required.