A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems.
BACKGROUND
A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.


METHODS
We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.


RESULTS
We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).


CONCLUSIONS
Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
Taylor
Tatiana L
TL
Research Department of Mental Health Sciences, UCL Medical School, London, UK. ttaylor@medsch.ucl.ac.uk
Killaspy
Helen
H
Wright
Christine
C
Turton
Penny
P
White
Sarah
S
Kallert
Thomas W
TW
Schuster
Mirjam
M
Cervilla
Jorge A
JA
Brangier
Paulette
P
Raboch
Jiri
J
Kalisová
Lucie
L
Onchev
Georgi
G
Dimitrov
Hristo
H
Mezzina
Roberto
R
Wolf
Kinou
K
Wiersma
Durk
D
Visser
Ellen
E
Kiejna
Andrzej
A
Piotrowski
Patryk
P
Ploumpidis
Dimitri
D
Gonidakis
Fragiskos
F
Caldas-de-Almeida
José
J
Cardoso
Graça
G
King
Michael B
MB
D054976:Clinical Governance; D003156:Community Mental Health Services / Q000458:organization & administration / Q000592:standards; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007326:Institutionalization / Q000592:standards*; D008134:Long-Term Care / Q000592:standards; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000534:rehabilitation / Q000628:therapy; D012949:Social Work, Psychiatric