Assisted living for people with mental illness in Finland
Thesis event information
Date and time of the thesis defence
Place of the thesis defence
Auditorium 1, Building PT1 of the Department of Psychiatry (Peltolantie 17)
Topic of the dissertation
Assisted living for people with mental illness in Finland
Doctoral candidate
Medical doctor Erfan Jahangiri
Faculty and unit
University of Oulu Graduate School, Faculty of Medicine, Research Institute of Clinical Medicine
Subject of study
Psychiatry
Opponent
Professor Jyrki Korkeila, University of Turku
Custos
Professor Sami Räsänen, University of Oulu
Assisted living for people with mental illness in Finland
Assisted living (AL) services were developed as part of dehospitalization to ensure coping in daily life, continuum of care and to facilitate rehabilitation in the community for the severely mentally ill (SMI). Although AL services have existed for decades research on the effectiveness of rehabilitation and outcome of residents in AL is scarce.
This study aimed to investigate the development of AL for people with mental illness, evaluate various outcomes of AL residents, and assess the rehabilitative effectiveness of AL in Finland. The study comprises a systematic literature review, service evaluation using national indicators, and a field study (Porvoo ASPA-project). National indicators were used to examine time trends in the development of AL in Finland over 23 years. The field study used AL unit level data from AL managers and AL resident level data from electronic patient records of the city of Porvoo. Feasibility of the international STAX-SA taxonomy was evaluated against the current Finnish three-level categorization.
The systematic review revealed a paucity of studies on rehabilitative factors of AL for the mentally ill. Of 21 articles reviewed, only nine presented a follow-up assessment. Time-trend analyses of national indicators showed that the decrease in psychiatric inpatient treatment was in line with the increase in AL use. Growth in outpatient care was also shown, but later and more slowly than the decrease in psychiatric inpatient treatment use. The international STAXSA taxonomy was able to categorize most high service level (24-hour and part-time) units but performed less well in categorizing units with low service level (supported living). During the three-year follow-up, only one-fifth of residents had moved on (rehabilitated) to less supported AL.
AL services for the mentally ill are needed especially for those with SMI affecting functioning and daily survival. The low number of move-on of AL residents might indicate that the trajectory of AL in Finland is developing towards more custodial care-type facilities rather than rehabilitative units. Potential reasons for this are lack of resources in outpatient care for these residents and the ongoing reduction of psychiatric inpatient treatment beds. Patients are discharged in increasingly worse condition to AL, without the capability to support residents according to their rehabilitative needs.
This study aimed to investigate the development of AL for people with mental illness, evaluate various outcomes of AL residents, and assess the rehabilitative effectiveness of AL in Finland. The study comprises a systematic literature review, service evaluation using national indicators, and a field study (Porvoo ASPA-project). National indicators were used to examine time trends in the development of AL in Finland over 23 years. The field study used AL unit level data from AL managers and AL resident level data from electronic patient records of the city of Porvoo. Feasibility of the international STAX-SA taxonomy was evaluated against the current Finnish three-level categorization.
The systematic review revealed a paucity of studies on rehabilitative factors of AL for the mentally ill. Of 21 articles reviewed, only nine presented a follow-up assessment. Time-trend analyses of national indicators showed that the decrease in psychiatric inpatient treatment was in line with the increase in AL use. Growth in outpatient care was also shown, but later and more slowly than the decrease in psychiatric inpatient treatment use. The international STAXSA taxonomy was able to categorize most high service level (24-hour and part-time) units but performed less well in categorizing units with low service level (supported living). During the three-year follow-up, only one-fifth of residents had moved on (rehabilitated) to less supported AL.
AL services for the mentally ill are needed especially for those with SMI affecting functioning and daily survival. The low number of move-on of AL residents might indicate that the trajectory of AL in Finland is developing towards more custodial care-type facilities rather than rehabilitative units. Potential reasons for this are lack of resources in outpatient care for these residents and the ongoing reduction of psychiatric inpatient treatment beds. Patients are discharged in increasingly worse condition to AL, without the capability to support residents according to their rehabilitative needs.
Last updated: 30.9.2024