Do the characteristics of high support accommodation predict the needs of mental health consumers?

Objective The primary aim of this study was to explore the relationship between key accommodation and support characteristics and the needs of mental health consumers in high support accommodation. The second aim was to ascertain whether consumers in these settings had levels of need and functioning commensurate with the high levels of support being provided. Method A sample of consumers accessing high support, very high support and residential rehabilitation services (as defined by NSW Health, 2002) were identified. Interviews were conducted using the Camberwell Assessment of Need to assess consumer perceptions of need and satisfaction with the type and amount of help received. Staff ratings of functioning were collected using the Life Skills Profile�16. Thirteen characteristics of the accommodation acknowledged in published research as being preferred by consumers were identified: (a) Service is no further than 1km away from transport; (b) service is no further than 1km away from community facilities; (c) the service does not own the property in which consumers reside; (d) the service separates the management of the property (e.g. rent collection, maintenance etc.) from the provision of support; (e) each consumer signs a separate lease; (f) consumers are not required to adhere to service-specific house rules; (g) consumers are not required to move out of their accommodation when their needs change; (h) one and two bedroom facilities are available; (i) consumers are offered a choice of housing options on application; (j) each consumer has their own bedroom; (k) staff are not based at the accommodation; (l) staff are not present 24 hours a day; and (m) support is available on an outreach basis. The relationship between these characteristics and consumer perceptions of need and satisfaction were explored. Comparisons were also made between services providing 24-hour staff support and those less intensively staffed. Results One hundred and sixty-five consumers from 26 services across New South Wales and the Australian Capital Territory were interviewed. Seventy-five percent of the sample was male and the mean age was 43 years. Consumers had on average 7.6 needs of which 2.1 were unmet. Of the thirteen consumer preferred characteristics identified, only on-site staffing, property ownership, signing a lease and 24-hour staffing predicted the number of needs identified by consumers. There were six characteristics which predicted the types of needs consumers expressed with the availability of 1 and 2 bedroom accommodation featuring in models which predicted need in the health, basic and service CAN sub-domains. Consumers of 24-hour services had a significantly shorter length of stay and more unmet needs than consumers of less intensively staffed services. They were also significantly less satisfied with the amount of help they received than consumers without this level of support. Needs in the basic and services sub-domains differentiated consumers of 24-hour services from those receiving less staff support. Consumers with a high level of need did not have a correspondingly low level of functioning and consumers residing in services with 24-hour staffing had significantly higher levels of functioning. Conclusions Results did not support the hypothesis that consumers of services implementing higher numbers of consumer preferred characteristics have fewer unmet needs and higher levels of satisfaction. Whilst increasing the availability of consumer preferred models of accommodation remains a priority, this may not lead to a reduction in need and associated reduction in the intensity of service required. However, the identification of specific areas of need could lead to better targeted service provision. The fact that consumers of very high support services have almost the same number of needs as consumers of high support services raises questions about the screening processes used by services to assess the suitability of referrals and the availability of less intensively staffed accommodation for consumers whose needs for care reduce