title: Opening Doors to Recovery: Recidivism and Recovery Among Persons With Serious Mental Illnesses and Repeated Hospitalizations.
abstract: OBJECTIVE
  Repeated hospitalizations and arrests or incarcerations diminish the ability of individuals with serious mental illnesses to pursue recovery. Community mental health systems need new models to address recidivism as well as service fragmentation, lack of engagement by local stakeholders, and poor communication between mental health providers and the police. This study examined the initial effects on institutional recidivism and measures of recovery among persons enrolled in Opening Doors to Recovery, an intensive, team-based community support program for persons with mental illness and a history of inpatient psychiatric recidivism. A randomized controlled trial of the model is underway.
  
  
  METHODS
  The number of hospitalizations, days hospitalized, and arrests (all from state administrative sources) in the year before enrollment and during the first 12 months of enrollment in the program were compared. Longitudinal trajectories of recovery-using three self-report and five clinician-rated measures-were examined. Analyses accounted for baseline symptom severity and intensity of involvement in the program.
  
  
  RESULTS
  One hundred participants were enrolled, and 72 were included in the analyses. Hospitalizations decreased, from 1.9±1.6 to .6±.9 (p<.001), as did hospital days, from 27.6±36.4 to 14.9±41.3 (p<.001), although number of arrests (which are rare events) did not. Significant linear trends were observed for recovery measures, and trajectories of improvement were apparent across the entire follow-up period.
  
  
  CONCLUSIONS
  Opening Doors to Recovery holds promise as a new service approach for reducing hospital recidivism and promoting recovery in community mental health systems and is deserving of further controlled testing.
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Compton
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kelley
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Alicia
authors.initials: A
authors.lastname: Pope
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Smith
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Beth
authors.initials: B
authors.lastname: Broussard
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Reed
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: June A
authors.initials: JA
authors.lastname: DiPolito
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Charles
authors.initials: C
authors.lastname: Li
authors.affiliation: Dr. Compton and Ms. Broussard are with the Department of Psychiatry, Lenox Hill Hospital, New York (e-mail: mcompton@nshs.edu ). Dr. Kelley is with the Department of Biostatistics and Bioinformatics and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Ms. Pope, Ms. Smith, and Ms. DiPolito are with Pineland Behavioral Health/Developmental Disabilities, Statesboro, Georgia. Mr. Reed is with the Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, D.C. Dr. Li is with the Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta. Ms. Lott Haynes is with the National Alliance on Mental Illness-Savannah, Savannah, Georgia.
authors.forename: Nora
authors.initials: N
authors.lastname: Lott Haynes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services; D003415:Crime / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005845:Georgia; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D019964:Mood Disorders / Q000534:rehabilitation; D011618:Psychotic Disorders / Q000534:rehabilitation; D020127:Recovery of Function; D012008:Recurrence; D019966:Substance-Related Disorders / Q000534:rehabilitation; D055815:Young Adult