Determinants of Continuity of Care for Persons Transitioning from State Psychiatric Facilities to Communities

When individuals with serious mental illness are discharged to the community, continuous and coordinated care are both desirable and necessary. A lack of continuity places the individual at risk for becoming lost to further services. This study explores continuity of care for persons discharged from state psychiatric facilities in Virginia to communities. Continuity of care is defined as the successful initiation and maintenance of face-to-face contact by CSB staff with individuals to be discharged from state hospitals, and the subsequent provision of services post-discharge. This study identifies factors that influence continuity of care, examines the degree to which these factors play a role and the relationships between continuity of care and client characteristics. Predictor variables include characteristics of the population-at-risk: predisposing factors (i.e., age, gender, race), enabling factors (i.e., living situation, catchment area change, and geographic location of the CSB) and need factors (i.e., length of stay, legal status, and primary diagnoses). Data sources include two large data bases, 1) survey of CSB staff on the outcome of individuals discharged to their area in FY 1992, and 2) demographic information from state mental health authority. Findings from the survey show that 83% of persons discharged had a record of the discharge at the CSB. Inhospital contact by CSB staff prior to discharge was lower (54%). Results show that individuals are more likely to receive continuity of care if they are discharged to a CSB in a rural area, have a diagnosis of schizophrenia, and do not have a primary diagnosis of substance abuse. The theoretical framework, based on the Community Support System principles and the notion of vulnerability, leads to important policy and practice implications. For example, the study suggests that new and different programs might be more effective for individuals with substance abuse diagnoses, especially in urban areas. Recommendations include a mandate for nursing provision of services, or oversight of services to assure continuity of care between service settings. Future research could improve upon the measurement of the variables, and examine consumer and provider perceptions of continuity of care as an outcome