Integrated Community Mental Health Services (ICMHS): Quality of Life and Patient Satisfaction

Purpose:

There is no fixed definition of integrated community mental health service (ICMHS) (England & Lester, 2005; Kodner & Spreeuwenberg, 2002); and a review of the literature indicated a paucity of studies in evaluating the outcomes of this service.  Various yet segregated approaches of mental health services have been utilized in Hong Kong in the community.  In this connection, the government has established the Integrated Community Centre for Mental Wellness (ICCMW) since October 2010 in all districts with a view to enhance the multi-disciplinary community support to patients and re-integrating them better into the community. It is necessary to investigate the outcomes of this newly introduced ICHMS with patient-defined outcomes for further service development.

This study aimed to investigate and enhance the understanding of patients’ quality of life (QOL) and patient satisfaction after discharge from an ICCMW.

Methods:

The design was a quantitative descriptive and correlational study.  The setting was one of the 24 ICCMWs out of 18 districts in Hong Kong.  Upon receiving informed consent of the participants, the study was conducted by face-to-face interview or phone interview with the Lehman Quality of Life Interview – Brief Version (QOLI – BV) (Lehman, Kernan, & Postrado, 1995) plus demographics collection (Section A) of the Full Version (Lehman, 1983); and the Risser Patient Satisfaction Scale – Chinese Version (RPSS – CV) (Chan & Yu, 1993; Risser, 1975).

There were a total of 206 clients discharged from the identified ICCMW with at least one psychiatric diagnosis categorized by DSM-IV who were discharged from March 2011 to March 2013.  Among these patients, 169 were contacted and 53 patients agreed to participate in the study.

Results:

There were 67.9% of the participants who expressed satisfaction in General Life Satisfaction subscale of the QOLI – BV with an overall mean of 4.86 (SD 1.19) at the level of neutral tending to satisfied. The overall Patient Satisfaction was also neutral tending to satisfied (mean 3.66, SD 0.27).  For QOLI – BV, gender (p = 0.017) and household composition (p = 0.033) contributed to significant differences in the sub-scale of Satisfaction with Social Relations; while there was a significant difference in General Life Satisfaction between different household compositions (p = 0.044).  The areas of patient satisfaction with the service of ICCMW included genuine and welcoming staff; professional and diligent staff; popular group events and follow-up services; and the instrumental and psychosocial support. Patients also raised several areas for improvement: to increase frequency and duration of contacts, to maintain continuity of services, to enhance promotion of events, to expand services and resources, and to improve professionalism of staff. No significant correlation was found between QOL and patient satisfaction.

Conclusion:

From the results of this study, there is room for improvement in educating about the treatment and progress of specific mental illnesses for individual patients who attended the service of ICCMW.  Increased attention should be paid to the needs of patients, particularly for those without a partner in the community. More efforts may be put in improving patients’ social relations, such as to set up a daytime drop-in service in ICCMW. For future studies, a specific QOL and patient satisfaction scale for ICMHS may be developed to better evaluate the outcomes of such service. Furthermore, qualitative studies should be conducted in order to better understand the experience and outcomes of post-ICCMW community life for the mental health patients.