title: Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU).
abstract: An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes.
  
  
  
  A brief description of the unit's establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations.
  
  
  
  The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = -1.15), followed by Social-connection (z-change = -0.82) and Self-belief (z-change = -0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern.
  
  
  
  This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.
authors.affiliation: School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW, 2308, Australia.|Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Barry G
authors.initials: BG
authors.lastname: Frost
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Turrell
authors.affiliation: Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.|MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Ketrina A
authors.initials: KA
authors.lastname: Sly
authors.affiliation: Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia. Terry.Lewin@hnehealth.nsw.gov.au.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia. Terry.Lewin@hnehealth.nsw.gov.au.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. Terry.Lewin@hnehealth.nsw.gov.au.|MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia. Terry.Lewin@hnehealth.nsw.gov.au.
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Lewin
authors.affiliation: Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.|Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.|MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Agatha M
authors.initials: AM
authors.lastname: Conrad
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Johnston
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Tirupati
authors.affiliation: Nurse Unit Manager (2010-2015), ISMHU, Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.
authors.forename: Kerry
authors.initials: K
authors.lastname: Petrovic
authors.affiliation: Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.|School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
authors.forename: Sadanand
authors.initials: S
authors.lastname: Rajkumar
mesh_terms: D000328:Adult; D017028:Caregivers; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008605:Mental Health Services / Q000639:trends; D010351:Patient Discharge; D012112:Residential Facilities; D019467:Subacute Care / Q000458:organization & administration*
keywords: Health service evaluation; Inpatients; Mental disorders; Mental health services; Recovery; Rehabilitation; Serious mental illness; Sub-acute