Step-up, step-down mental health care service: evidence from Western Australia's first - a mixed-method cohort study.

BACKGROUND: Mental health Step-up, Step-down services (SUSD), also known as subacute services or Prevention and Recovery Services, have emerged to fill an identified gap between hospital-based inpatient care and clinical community-based mental health support. Evidence for the effectiveness of the SUSD service model is limited but growing. Accordingly, this study looked to add to the extant body of knowledge, by (i) assessing change outcomes in mental health and wellbeing, and predictors of these changes, for patients who accessed Western Australia's first SUSD service; and (ii) evaluating patients' satisfaction with service, and what patients value from their stay. METHODS: This was a mixed-method retrospective cohort study. Participants comprised 382 patients who accessed a 22-bed Mental Health SUSD facility and incurred 551 episodes of care during the 01/07/2014-30/06/2016 period. Patients' change outcomes in psychological distress, general self-efficacy, and work and social adjustment from service entry to service exit were analyzed using generalized linear modeling. Simple Pearson's correlation coefficients were calculated for preliminary assessment of the associations between patients' service satisfaction and their change outcomes. Qualitative outcomes that patients valued from their stay were analyzed thematically according to a semi-grounded theoretical approach. RESULTS: Significant improvements were observed in patients' self-reported psychological distress, self-efficacy, and work and social adjustment (all p < 0.0001). A strong and persistent baseline effect existed across the three measures. Older age, female gender, and having a dependent child in the same household were protective/enhancing factors for the patients' recovery. Satisfaction with service was high. Patients valued having the time and space to recuperate, gain insight, focus, and create changes in their lives. CONCLUSION: The encouraging findings, regarding both patients' change outcomes and satisfaction with service, support the value of the SUSD service model for patients with mental illnesses. Strengths and limitations were discussed; ensued recommendations were offered to both service providers and researchers to enhance the robustness of future research findings, to help inform more effective policy and funding decisions related to mental health care.

Health literacy in people living with mental illness: A latent profile analysis.

Health literacy comprises cognitive and social skills that enable people to understand health information and maintain good health. Research examining the health literacy of people living with mental illness is scarce. The aim of the present study was to identify distinct subgroups of health literacy in individuals attending mental health treatment and determine if profiles and health literacy levels differ from other populations accessing healthcare services and on health characteristics. Participants (N = 325) were attending Neami National Australia services. Participants completed the multidimensional Health Literacy Questionnaire. Latent profile analysis was conducted to identify health literacy profiles. Participants reported lowest health literacy scores in appraising health information, navigating the healthcare system, and finding good health information. Three health literacy profiles were identified; low (20.4%), moderate (61.3%), and high (18.3%). Compared to the other populations (i.e. private hospital patients, men with prostate cancer, older individuals with diabetes, general population, people attending substance dependence treatment), the current sample tended to have lower health literacy scores. The findings highlight the need to increase overall health literacy and consider an individualised approach to enhance specific health literacy domains.