Barossa Hills Fleurieu Local Health Network/ Rural and Remote Mental Health Service, Angaston, Australia.
Flinders and Upper North Local Health Network/ Whyalla Integrated Mental Health Service, Whyalla, Australia.
PLoS One. 2021 Nov 23;16(11):e0260250. doi: 10.1371/journal.pone.0260250. eCollection 2021.
As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents.
To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers.
A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants' perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically.
Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified.
Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes.
This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.
作为重大心理健康改革的一部分，社区心理健康康复服务（CMHRS）在南澳大利亚农村地区实施。CMHRS 是一个 10 张床位的精神健康住院康复计划，为农村居民提供康复精神健康支持。
分析 CMHRS 的服务交付模式及其对消费者康复结果的影响。
采用混合方法、现实主义评估方法。招募了 CMHRS 工作人员（n=6）和消费者（n=8）的目的抽样。使用 RAS-DS（入院和出院时）衡量消费者的康复情况。通过一个工作人员焦点小组（n=6）和个别半结构化访谈（消费者 n=6；工作人员 n=2）获得参与者对服务的看法。使用配对 t 检验/Wilcoxon 配对符号秩检验分析 RAS-DS 前后得分，对定性数据进行主题分析。
出院时 RAS-DS 总分显著增加，得到定性主题（重建）关系和社会联系以及恢复健康和幸福感的支持。确定了影响服务实施的背景因素（如人员配置）和计划机制（如日程安排）。
保持以康复为重点的方法，并辅以适当训练的多学科团队，对于最大限度地提高消费者的积极成果至关重要。
这项现实评估确定了影响农村心理健康康复服务交付的关键因素。
