Predictors of Discharge from Hospital to Supported Accommodation and Support Needs Once in Supported Accommodation for People with Serious Mental Illness in Scotland: A Linked National Dataset Study

Abstract

Background. Many individuals with serious mental illness live in supported accommodation. Decisions regarding type of supported accommodation required and level of support to meet individual’s needs are crucial for continuing rehabilitation and recovery following admission to hospital. This study aimed to identify personal and contextual predictive factors for (1) discharge from hospital to different levels of supported accommodation and (2) self-directed support needs of individuals with serious mental illness once they are in supported accommodation in Scotland. Method. Linked data from the Scottish Morbidity Record-Scottish Mental Health and Inpatient Day Case Section and the Scottish Government Social Care Survey were analysed using multinomial regression and multivariable logistic regression to identify personal and contextual factors associated with accommodation destination at the time of discharge and four self-directed support needs: personal care; domestic care; healthcare; and social, educational, and recreational. Results. Personal factors (age and having a diagnosis of schizophrenia, schizotypal, or delusional disorder) were associated with individuals moving to supported accommodation with higher levels of support. One contextual factor, compulsory detention when admitted to hospital, decreased the likelihood of moving to any type of supported accommodation. The personal and contextual factors associated with identified self-directed support needs varied by need. Support provided by the local authority was associated with all self-directed support needs, with having a diagnosis of schizophrenia, schizotypal, or delusional disorder associated with identifying domestic care, healthcare, and social, educational, and recreational needs, while living in the most deprived areas was associated with identifying healthcare needs. Advancing age and being compulsorily detained decreased the likelihood of identifying social, educational, and recreational needs. Conclusion. The study highlights that older men with a diagnosis of schizophrenia, schizotypal, or delusional disorder require higher levels of support upon discharge from hospital. When living in supported accommodation, having this diagnosis increases the likelihood of identifying support with looking after the home, looking after their health, and social and recreational activities; however, being older decreases the likelihood of identifying support with social and recreational activities.