Factors predicting discharge of patients from community residential facilities: A longitudinal study from Italy

Objective: Community residential facilities for psychiatric patients have increased in Italy in the last years, but little information is available on their use, the patients they host, the interventions they deliver and the rate at which they discharge patients. To investigate these issues, we conducted a longitudinal study in 2000-2001 on all the community residential facilities in Lombardy, a large region in North Italy. Method: The study base comprised all the patients residing in the community residential facilities identified in Lombardy in 2000. Out of the 196 community residential facilities identified, 91% agreed to participate. The study sample consisted of all the patients living in the residential facilities on 15 November, 2000. A total of 1792 patients were recruited and described. Results: In the study period, a total of 316 patients were discharged. Among these, 191 (11%) went to lower-protection settings or home and 49 (3%) to higher-protection settings. The probability of discharge to lower-protection settings and home was higher for people in residential care centres, not coming from a psychiatric hospital, having shorter duration of the current admission, having work at the time of admission and with a low HoNOS score. Associations were found between discharge to higher-protection settings and old age, inadequate accommodation in staff opinion, and the public sector managing the facility. Conclusions: Turn-over of patients in the community residential facilities was limited. Discharges to higher-protection settings were related to need for specific care for older patients. Type of facility and duration of stay predicted discharge to lower-protection facilities and home independently from other patient characteristics. If a higher turn-over and a more extensive use of this resource must be achieved, roles of other psychiatric and social community-based services should be taken into account.