Fostering independence: Transitioning residents with severe mental illness to independent living

Abstract

The overall aim of the research described in this thesis was to explore the transition of people with severe mental illness (SMI) from community housing programs towards more independent living. The work described in this thesis contributes to our knowledge and understanding of factors that support or hinder people with SMI in the transition from supported housing towards more independent forms of living. The thesis comprises four parts (chapters 2-6), addressing the following question: “What factors contribute to the transition of people with SMI living in supported housing facilities toward more independent forms of living?” Chapter 2 reviews the effectiveness and different approaches of supported housing, before the third chapter describes the care needs and expectations of people with SMI who were on a waiting list for supported housing. It also explores whether these individuals felt they were adequately informed about supported housing. The fourth chapter examines associations between the functional outcomes of people with SMI and the personality traits of their case managers. Chapters 5 and 6 investigate variables that may predict the transition of people with SMI from supported housing to more independent living arrangements. Summary of the main findings At the start of SH, there must be adequate information provision so that people with SMI can have clear expectations. Once the person with SMI receives care within SH, the continuity of care should be ensured. The conscientiousness of case managers was associated with an increased self-reliance of the person with SMI living in SH over a period of two years. People with a personality disorder, with current alcohol misuse, or who received ambulant care prior to admission in SH had the highest probability of moving into a more independent way of living. Moreover, people with SMI who no longer felt safe in their current home were significantly associated with making a positive transition. People who received clinical care prior to admission in SH and people with a history of substance dependency had the highest probability of transferring to a less independent way of living or clinical relapse. We hope that the results of this thesis will assist organizations and policy-makers to implement changes that will enhance the rehabilitation and quality of life of people with SMI.