Open Collections

The transition of British Columbia’s tertiary psychiatric services from hospital to community : consideration of clinical, psychosocial, and transinstitutionalization outcomes

University of British Columbia

Deinstitutionalization of severely and persistently mentally ill individuals has been one of the most significant developments in mental health policy and practice in the last 70 years. This dissertation is comprised of four interconnected papers which together examine the redevelopment of tertiary psychiatric services in British Columbia (BC). The first paper reports on a cohort of patients who moved from Riverview Hospital (RVH), BC’s only large-scale tertiary psychiatric hospital, to community-based facilities in the Vancouver Island, Interior, Northern, and Fraser Health Authorities between 2001 and 2004. The variety and characteristics of the facilities participants moved to over the course of the RVH closure and changes in clinical and psychosocial characteristics of participants over a 5-year period are described. The next paper considers the psychosocial, clinical, and risk profile of the final cohort of RVH patients and compares and contrasts those characteristics with a forensic sample. In addition, the prevalence of a variety of negative outcomes (i.e., aggression, inappropriate sexual behaviour, self-harm, suicide, self-neglect, unauthorized leave, substance abuse, victimization, and stalking) in a six month time frame are compared. The third paper is a validation of the Short-Term Assessment of Risk and Treatability (START) in forensic mental health practice. It addresses three specific research questions: (1) What is the clinical and risk profile of a large Canadian forensic psychiatric cohort? (2) What are the psychometric properties of the START in a forensic service when the evaluations are completed by clinical teams? (3) How are these profiles and START outcomes similar or different among male and female patients and across various settings (i.e., hospital versus clinic) or security levels (i.e., maximum, medium, minimum)? The fourth paper compares the psychometric properties of START in a forensic and civil psychiatric sample. The results from this dissertation provide evidence that a well-planned and well-resourced closure of a civil psychiatric hospital do not lead to negative outcomes such as transinstitutionalization and homelessness and suggest that START is a potentially useful tool for psychiatric patients.

Text

2015-07-29

Attribution-NonCommercial-NoDerivs 2.5 Canada

http://hdl.handle.net/2429/54226

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/2.5/ca/