title: Living conditions and quality of care in residential units for people with long-term mental illness in Portugal--a cross-sectional study.
abstract: BACKGROUND
  As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users' characteristics and experiences of care.
  
  
  METHODS
  All longer term mental health units in Portugal providing on-site staffed support for at least 12 h per day were assessed with the Quality Indicator for Rehabilitative Care (QuIRC), a standardised tool completed by the unit manager. The QuIRC rates seven domains of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self/Management and Autonomy, Recovery Based Practice, Social Inclusion, and Human Rights). A random sample of service users were interviewed using standardised measures of autonomy, experiences of care and quality of life.
  
  
  RESULTS
  Most (60 %) of the 42 units were in Lisbon and surrounding districts with 50 % based in the community and 50 % in hospital settings. They had a mean of 11.5 beds. Service users (n = 278) were mainly men (66.2 %), with a diagnosis of schizophrenia (72.7 %), and a mean age of 49.4 years. Community units scored higher than hospital units on the Living Environment, Treatments and Interventions, and Self-Management and Autonomy domains of the QuIRC. Increased service user age was negatively associated with all but one domain. All QuIRC domains were positively associated with service users' autonomy and experiences of care.
  
  
  CONCLUSIONS
  Investing in better quality, community based mental health facilities is associated with better outcomes for service users who require longer term support.
authors.affiliation: Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal. gracacardoso@gmail.com.
authors.forename: Graça
authors.initials: G
authors.lastname: Cardoso
authors.affiliation: NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal. anapapoila@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Papoila
authors.affiliation: Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal. gina.tome@fcm.unl.pt.
authors.forename: Gina
authors.initials: G
authors.lastname: Tomé
authors.affiliation: Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road,, London, W1T 7NF, UK. h.killaspy@ucl.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Killaspy
authors.affiliation: Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road,, London, W1T 7NF, UK. m.king@medsch.ucl.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal. caldasjm@fcm.unl.pt.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Caldas-de-Almeida
mesh_terms: D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006778:Hospitals, Psychiatric; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008603:Mental Health; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D012924:Social Conditions