Residential Options for the Institutionalized Chronically Mentally Ill: The Impact of Psychosis on Choice

• Main Author: Stanek, Richard James
• Format: Others
• Published: PDXScholar 1993
• Subjects: Mentally ill > Housing; Psychoses; Psychology
• Online Access: https://pdxscholar.library.pdx.edu/open_access_etds/4631; https://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=5702&context=open_access_etds

Discharge planning for hospitalized chronically mentally ill usually involves only verbal descriptions of community residential options. Psychosis often impairs ability to conceptualize abstract information, and quality of the choice process may be poor without describing options in concrete form, i.e., using written descriptions and photographs. A random sample (N= 90) of Dammasch State Hospital (Wilsonville, Oregon) patient population, comprising persons diagnosed schizophrenic, schizoaffective, organic mental disorder, and bipolar, were assigned to three treatment groups, asked to rank six community residential options suited for them when they were ready to leave the hospital. The three treatment groups were presented the same set of residential options, but the manner of presentation of options was manipulated: first group received verbal descriptions, second group received verbal descriptions with placards containing printed highlights of descriptions, third group received verbal descriptions, printed descriptions, and five photographs of each type of residential option. After ranking the options, respondents were asked how difficult it was to make their choices: very difficult, kind of difficult, not very difficult. Finally, an open-ended question was asked, "What guided you in making your choices?" Respondents' social workers were asked to rank same six residential options for each respondent. Chisquare and Kruskal-Wallis tests were computed for treatment groups-by-respondents' choices for first through sixth choice with no significance found. "Difficulty of Choice"by- treatment group analyses found no significance using Kruskal-Wallis test, and trend toward significance using chi-square. Content analysis of open-ended question, "What guided you ..• " yielded seven categories of answers, and chi-square of "What guided you"-by-respondents' first choice of residential setting was significant. "Experience" and "Privacy and Independence" were most influential factors from content analysis, but only trends toward significance were found in chi-square, cross-tabulating them by treatment group. Since cross-tabulation of respondents'-by-social workers' choices showed no significance, six rankings were collapsed into three and significance was found for supported housing option (respondents and social workers choosing it in common third or fourth) for total sample. Other significance was found in verbal treatment group for homeless shelter (chosen in common fifth or sixth), and for supported housing (chosen in common third or fourth). Rank correlations of respondents' and social workers' choices for total sample found significant negative relationship for room and board option. Rank correlations of choices by treatment group found significant negative relationship for room and board in the verbal treatment group; found significant positive relationship for residential care facility in the verbal/written treatment group; found significant negative relationship for room and board option in the verbal/written/visual treatment group. Abstraction deficits evidently do no affect the way chronically mentally ill persons choose residential options. The chronically mentally ill also do not find choosing a residential placement any more or less difficult given the presentation of written and visual descriptions in addition to verbal description. Given excess of "not very difficult" answers to "difficulty" question, validity of "difficulty" question to detect quality of choice process is questionable. Better outcome question may have been, "How satisfied are you with you choices?". Given distribution of respondents' and social workers' choices, compromise between independent living and residential care facility is suggested in choice of supported housing program.