Successful community living for people with schizophrenia:the role of compensatory support

Abstract

People with schizophrenia return to hospital more than any other mental health group. This thesis examines supports that assist people with schizophrenia reduce psychiatric hospital admissions.

Research Project One, a retrospective cohort design, analysed archival data of adults with schizophrenia. Psychiatric hospital utilisation over 12 months after discharge from hospital was the outcome of interest. Being younger, male, a lower cognitive level as measured by the Allen Cognitive Level Screen (ACLS), and receiving formal support were some factors associated with increased return to hospital.

Research Project Two, a five-stage scoping review, explored the relationship between the ACLS scores, function and community living for adults with a mental illness. Data from 15 studies were charted, collated, numerically and thematically analysed. A positive relationship was found between the ACLS and functional performance. Studies examining community living, showed mixed results. Results of Projects One and Two indicated that cognition, as measured by ACLS, was only one factor impacting community living.

The third project explored the lived experience of adults with schizophrenia and the supports they identified as helping them reduce hospital utilisation via semi-structured (N=18). Data were thematically analysed using constant comparative analysis. An inductive phase of analysis was followed by a deductive phase. Participants described the types of support they found helpful and the importance of support quality.

Key findings from the research include:

• living in the community with schizophrenia is complex

• fluctuations in person-occupation-environment and cognitive challenges impacts community living for people with schizophrenia

• the ACLS provides a good indication of functional performance, but there is limited evidence for prospective adaptive functional performance

• greater collaboration with people with lived experience of schizophrenia is needed.