The Factors Affecting the Quality of Life of the Residents with Chronic Mental Illness in Urban Halfway Houses

• Main Authors: Min-Chen Yao, 姚敏貞
• Other Authors: Chung-Fu Lan
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/63907389616015069611

碩士 === 國立陽明大學 === 衛生福利研究所 === 93 === Abstract In the past decade, the policies with incentives had facilitated the substantial growth in establishment of psychiatric rehabilitation institution (PRI). The Half-Way Houses (HWHs) have mushroomed in urban area of Taipei. By the end of 2004, there are 25 HWHs being set up in Taipei, about one third of the sort in Taiwan, and all belong to private organization. Nevertheless, they are beyond evaluation on their effectiveness and performance. In light of the need for community-based rehabilitation service systems to develop policies of improving the quality of life (QOL) for the residents, the present study examines whether characteristics of the environment of HWHs associated with residents’ quality of life (QOL). The specific characteristics of the environment were depicted with facility, size, staffing, employment, rehabilitation care, management model, resident personality and the degree of variety and stimulation of the physical environment. By method of cross-section analysis based on quantitative and empirical researches, it is expected to find out the significant predictors. Baseline assessments were conducted in March 2005 for 463 residents with mental illness living in 23 HWHs in the city of Taipei. Through interview and staff consultation, a closed-ended questionnaire was developed to gather demographic, health and service information, quality of life assessments, environmental assessments and information about categories of service-related problems. The (GAF) scale was used to assess symptom severity. The entry criteria of the survey were that the residents with GAF scored above 41 had to be verbal, living in the current accommodation for at least 6 months at the time of study. Consequently, the effective sample was 254 residents with mental illness being assessed. Individual responses were coded and then manually entered into a standardized computer analysis program, Statistical Package for Social Sciences (SPSS) Version 11. Data were analyzed by descriptive statistics, independence samples t-test, Pearson correlation and multiple linear regressions. The major results of this cross section study based on quantitative and empirical researches indicated as follows: 1.Participants’ age and education level were higher than that of related researches. Most were single, unmarried. Employment showed lower number, only 4.3% of the informant. Nearly 90% of subjects were diagnosed as schizophrenia. Average length of illness was 17.2 years. At lease 60% of participants were categorized as stable symptom with good functioning and compliance in medication. In a period of one year living in the HWHs, the residents’s relapse occurrence was only 16%. Most of informant entered into HWHs on request of family members. More than 50% of participants were covered by both National Health Insurance and other social welfare. Residents stayed longer than 2 years were 5.6%. 2.Most of HWHs located by the avenues in urban area, accessible by bus or Metro transportation system. House structure was type of ground floor in apartment building or adjacent floors. In regard to the physical environment, there was similar percentage (37.8%vs37.4%) between yard included and yard excluded. Indoor entertainment facility was mostly well-equipped, while private space and application of kitchen function training were partly insufficient. In terms of professional care staffing, many HWHs operate with the assistance of only one trained full-time nurse, while physician, social worker and therapist work part-time. Among caring activities, physical exercise to improve residents’ health apparently fell short of expectations. As for the door control to residents, many HWHs adopt semi-open type of admittance. 3.Subjects did not positively take part in the residential rehabilitation group activities, while a majority of 70% informants joined either in-house service work or supportive employment, which were sort of handicraft or assistant job. Nearly 80% of the workers get the monthly pay lower than NTD2,000, with which, more than 50% of the subjects felt satisfied. Even if not, the expected amount were no more than NTD5,000. 4.A majority of 80% residents agreed that psychiatrics with stable symptom need the job. When self-evaluating physical or psychological condition, they could take a load of 5 hours per day. Among the array of community rehabilitative services, most of the residents were interested in the supportive employment program. 5.As a whole, the quality of life among HWHs residents in Taipei is slightly better than that of middle level. Four categories of quality of life scored 51.66 in average, and physical domain got the highest. The best predictors in each category were listed in sequence as follows: Physical health domain (R2: 0.183): the affecting factors are 1. psychiatric symptom, 2.HWHs location. Psychological domain (R2: 0.094): the affecting factors are 1. psychiatric symptom, 2.outdoor space. Social relationships domain (R2: 0.109): the affecting factors are 1. experience about workshop, 2. satisfaction with work reward, 3. psychiatric symptom. Environment domain (R2: 0.311): the affecting factors are 1. psychiatric symptom, 2. satisfaction with work reward, 3. experience about workshop, 4. HWHslocation, 5. perception to illness, 6. salary. Total QOL (R2: 0.218): the affecting factors are 1. psychiatric symptom, 2. experience about workshop, 3. satisfaction with work reward, 4. HWHs location. The study recommended: 1.Through evaluation mechanism and substantial reward regulation, the government should energize the HWHs organizations, which can dedicate full efforts to buildup good community-based residential environment and rehabilitation activity. 2.To facilitate the goal of rehabilitation and maintain the quality of life, the HWHs residents should be re-categorized severely or mildly and chronic or acute residents into different health management system. 3.By fully executing the Bill of Protection on Mental Disability, the government should energize public and private organizations with service like business to provide assistance part-time job for those of residents with mental illness, and establish objective standard of salary pay for them. 4.Psycho-education courses to staffs in HWHs should be offered, which focused on the integration of community resources, design of rehabilitation programs and contents arrangement of group activity, so as to assure and upgrade quality of rehabilitation services. 5.Aside from the efforts to keep residents' symptom in stable, the institutional philosophy, functional role and job mission in HWHs as well as a comprehensive community rehabilitative support network should be re-evaluated and re-established in order to meet the indigenous socio-cultural environment. 6.The substantial policy should adopt the theory of society model instead of medical model and to build up a social environment with no barriers, to promote the quality of life and well-being for mental ill people dwelling and working in the community. 7.More subsequent researchers are recommends to further up on the quality of rehabilitation services in HWHs, including the way of improving it and developing related evaluation on economic effectiveness of the community psychiatric rehabilitation services.