THE MENTAL-HEALTH RESIDENTIAL CARE STUDY - CLASSIFICATION OF FACILITIES AND DESCRIPTION OF RESIDENTS

Background, The NHS is no longer a virtual monopoly provider of mental health residential care. This makes it difficult to assess the volume , range and adequacy of local provision. Method, Local data collectors used standard instruments to collect detailed information about 368 f acilities (with 1951 residents) providing mental health residential ca re in eight districts. Because local definitions were inconsistent, fa cilities were reclassified on the basis of facility size and extent of day and night cover. The eight categories of accommodation are compar ed on levels of staffing, staff qualifications and the characteristics of their residents. Results, There was a nearly threefold variation b etween districts in the total number of residential places available p er unit of population, and even greater variation in the number of pla ces with 24-hour waking cover. Most residents have long-term, severe m ental illness and severe impairment. Long-stay wards accommodate peopl e who pose greater risk of violence than do the two types of non-hospi tal facility with 24-hour waking cover (P<0.001). The former also empl oy a much greater proportion of staff with formal care qualifications and, in particular, nursing qualifications than the latter (49% v. 15% , P<0.001). Conclusions, It is suggested that one consequence of the d iversification in provision of mental health residential accommodation has been a relative reduction in the proportion of provision availabl e to the most severely disabled. This might apply particularly to thos e who pose a risk of acting violently.