Supported accommodations for people with serious mental disorders: care pathways and experiences

Bárbara PEDROSA1,2, Graça CARDOSO1, Sofia AZEREDO-LOPES2, Manuel GONÇALVES-PEREIRA2, José Miguel CALDAS-DE-ALMEIDA1

1Lisbon Institute of Global Mental Health, Lisbon, Portugal
2NOVA Medical School, Lisbon, Portugal

Introduction

Supported accommodations (SAs) are key to community mental health care, but little is known about residents’ care pathways and the experiences and expectations of residents and professionals of SAs. This study aimed at analysing the care pathways of residents of SAs in Portugal and factors associated with their age of entry and length of stay; and, to explore the experiences and expectations of residents and professionals regarding the care provided by SAs.

 

 

Methods

On a first step, a random sample of 213 residents of 43 SAs responded to a specifically developed questionnaire aimed at assessing their care pathways. Associations between sociodemographic and clinical characteristics, age of entry, and length of stay, were analysed using hierarchical regression. On a second step,  a purposeful sample of 11 residents and 11 professionals from 11 different organisations managing SAs were included. Semi-structured interviews were conducted to explore their experiences and expectations and thematic analysis was used.

 

Results

Most residents were male, single, pensioners, and had early-onset psychotic disorders. On average, they integrated the current SA at around 50 years old and had a 4.5 year length of stay. Most had been in another SA before and expected to stay at the SAs in the long term. Most residents were satisfied with care, while professionals suggested several improvements, such as having more time allocation to work with the residents and revising limits of lengths of stay.

 

Conclusions

Findings suggest that residents spend several years in the residential pathway, with a significant proportion moving to more supported SAs; they are seldom involved in decision-making; and, most hoped to remain in the SAs. Implications apply to the political level (regarding the financing of SAs and the provision of community mental health care and other social supports) and the clinical level (regarding training and family interventions).