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The relationship between deinstitutionalization and quality of care in longer-term psychiatric and social care facilities in Europe: A cross-sectional study

Published online by Cambridge University Press:  23 March 2020

T. Taylor Salisbury ,
H. Killaspy  and
M. King
T. Taylor Salisbury*
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
H. Killaspy
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom
M. King
Affiliation:
Division of Psychiatry, University College London, London, United Kingdom
*
*Corresponding author. Division of Psychiatry, University College London, London, United Kingdom. E-mail address:tatiana.salisbury@kcl.ac.uk (T. Taylor Salisbury).
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Abstract

Background

The process of deinstitutionalization (community-based care) has been shown to be associated with better quality of life for those with longer-term mental health problems compared to long stay hospitals. This project aimed to investigate the relationship between national progress towards deinstitutionalization and (1) quality of longer-term mental health care (2) service users’ ratings of that care in nine European countries.

Methods

Quality of care was assessed in 193 longer-term hospital- and community-based facilities in Bulgaria, Germany, Greece, Italy, the Netherlands, Poland, Portugal, Spain and the UK. Data on users’ ratings of care were collected from 1579 users of these services. Country level variables were compiled from publicly available data. Multilevel models were fit to assess associations with quality of care and service user experiences of care.

Results

Significant positive associations were found between deinstitutionalization and (1) five of seven quality of care domains; and (2) service user autonomy. A 10% increase in expenditure was associated with projected clinically important improvements in quality of care.

Conclusions

Greater deinstitutionalization of mental health mental health services is associated with higher quality of care and better service user autonomy.

Keywords

Psychiatry in EuropeQuality of careSocial and cross-cultural psychiatry
Type
Original article
Information
European Psychiatry , Volume 42 , May 2017 , pp. 95 - 102
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

Abbreviations: DEMoBinc, Development of a European Measure of Best Practice for People with Long Term Mental Illness in Institutional Care; QuIRC, Quality Indicator for Rehabilitative Care; MENDit, Mental Health Service Deinstitutionalization Measure; WHO, World Health Organization; DISC, Discrimination and Stigma Scale; FTE, full-time equivalent; AICc, corrected Akaike Information Criterion.

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