Mental health consumers as transitional aides: A bridge from the hospital to the community

The move toward deinstitutionalization of individuals with severe mental illness (CMI) has placed increased demands on the community to provide mental health care services to individuals who would have previously remained for months or years in the care of state hospitals. Making a successful transition from hospitalization to the community offers an individual a higher degree of independence, as well as greater opportunity to maintain employment and to develop more stable, adaptive interpersonal relationships. Additionally, people who make a successful community transition often experience a higher quality of life than those who spend a major portion of each year confined to a state mental hospital (Bond & McDonel, 1991). However, despite the establishment of publicly funded Community Mental Health Centers (CMHC), there remains a large number of people with mental illness who, for a variety of reasons, do not receive adequate care in the community (Test & Stein, 1978; Cutler, 1992; Sherman, 1992). Many persons with severe mental illness, once discharged from the hospital, often never connect with the CMHC for available services (Boyd & Henderson, 1978; Schwartz, Spitzer, Muller, & Fleiss, 1980; Goering, Wasylenski, Farkas, Lancee, & Ballantyne, 1984; Benda, 1991; Moseley, 1994). Accordingly, a recent report by the Policy Research Project on Financing Care for the Chronically Mentally Ill (Warner, Harris, Kier & Rodriguez, 1990) indicated a widespread need for greater coordination of services between state hospital and CMHCs. During the five years from 1984 through 1988, the report found that about 56% of the persons admitted to state hospitals received a CMHC referral at discharge. Moreover, this study found that 44% of persons admitted to state hospitals completely disappear from the records somewhere between the hospital and the CMHC. In addition, despite their high potential for "falling between the cracks" once out of the hospital, only about 11% were provided case managers (Harper, Hoover, Jung, & Rienstra, 1990). A review of the literature on case management and continuity of care found that mental health consumers were being successfully trained as case manager assistants and peer counselors in several communities throughout the United States (Sherman & Porter, 1991). Based on information obtained from individuals during hospitalization, it was hypothesized that community services usage consistent with discharge treatment plans could be increased by providing high-risk individuals with a trained peer to work as a Transitional Aide (TA). Based primarily on the work done by Sherman (1991) and Toprack (1990), the following training program was designed. Three objectives were evaluated. The first objective concerned the feasibility of training individuals with severe and persistent mental illness to work as TAs. The second objective was to obtain a preliminary measure of the effectiveness of the TAs in facilitating CMHC attendance. Finally the retention and recidivism rate of the trainees was evaluated. Method The most difficult and critical decisions in implementing a consumer training protocol involve participant selection criteria. Acceptance into the training program required each applicant to meet the following criteria: 1) Demonstrate successful management of a severe DSM III-R Axis I mental illness through use of community resources for a period of at least thirty days. 2) Have had at least one previous hospitalization for mental illness. 3) Be at least 18 years of age. 4) Possess academic skills commensurate with high school level based on the Wide Range Achievement Test-Revised. 5) Have a valid driver's license or be familiar with and currently using mass transit. 6) Have a supportive social network available, as demonstrated by involvement in local supported living activities, residing with family, or have regular interaction with other people on a daily basis. …