Many of the institution that housed mental health patients have closed . With clients returning to live in community based housing in groups of 3 or 4 to a house staff check in supervise and assist in Social and personal aspects of care so that adjustment is easier. A nurse drops in with medication but other than that the structure appears to deliver a sense of normalluty for those assessed as suitable for such units

All true and the majority of the programs that I work with are community based, but we run inpatient programs for individuals who for shorter periods of time need an inpatient setting because of being a danger to themselves or others or gravely disabled.

We are looking for good ways to measure that the care they receive helps them.

Look at major health board NHS or Mental health surveys of patients progressions from institutions to communal living I am sure there must be someone who has charted or graphed progress in this area after all statistic especially ones that demonstrate a positive outcome and reintegration give such new ideas scope. It also allows us to see where wearknesses or flaws occur in system address them and make improvements 

Australia uses Health of the Nation Outcome Scale in both community and inpatient settings, along with a self-report scale (eg K-10).

HoNOS was developed in UK, and extensively tested in Australia.  Some basic training is required:

http://www.rcpsych.ac.uk/training/honos/generalinformation/faq.aspx

All good points made above. However, in US at least, long-term success of state hospital patient success in community living is spotty at best for many. Research needed on what I call "serial institutionalization." This is replacing multi-year (sometimes multi-decade) stays with multiple short-term stays in acute inpatient facilities (e.g., 15-20+ days 5-12 times/year). A realistic "good outcome measure" might be evidence that community-based services overtime reduce the number and duration of such rehospitalizations and extend and improve community integration. 

Thanks for both suggestions. I have been doing precisely what you suggest with our data - looking at people moved out of imd's into our community programs and then analyzing their trajectory over as much as 6 years.

What we find is that there is a real reduction, perhaps less in the use of psychiatric emergency services (although these decline as well, but not to the same degree) but definitely in the use of acute and subacute hospitalizations.

What makes this difficult, is data.When people are hospitalized outside of county systems (and outside of county) it is much harder to get good data.

(note coming out of an academic research background, I have found what is possible when one works in the field absolutely amazing.)

attached may be helpful

Article Standardized remission criteria in Schizophrenia

Another:

Article On the concept of remission schizophrenia

An informal way of measuring progress at the in-patient ward in a hospital I've worked with involved evaluating a few things:

1. Patient awareness of being ill

2. Patient level of distress in an informal environment (eg. while watching television)

3. ^Contrasted with patient level of distress after interaction with a psychiatric professional and talking about symptoms/illness (eg. after a therapy session, meeting with doctor, etc.)

4. Patient's comfort level when interacting with staff (specifically looking for signs of wariness, mistrust, hostility, etc.)

5. Patient's comfort level when interacting with other patients in an informal environment (eg. over meals, when watching television, during leisure hours)

6. Patient's willingness/comfort with regards to engaging in treatment

These tended to be very informal measures based off of observation by clinical staff, particularly nurses and social workers. They were the categories that people kept an eye out for and staff would add their impressions to notes.

Obviously, these are quite subjective measures! They could probably be measured with more precise measures/scales, but the goal of these evaluations wasn't to collect rigourous data. They were useful as a way of getting an initial picture of someone's state when they first entered the ward vs. their state as their stay progressed. So someone who showed visible distress in informal environments as well as a lot of distress during/after treatment sessions, and who seemed very wary of interacting with staff and other patients might be assumed to be getting better if they progressively were more comfortable interacting with other patients in an informal setting and seemed to feel more okay talking with staff for more than just basic logistical things (like "yes, I want the pasta" or "I already had a shower today") and showed an interest in getting better.

I would just stress also that category 4 and 6 should *not* be construed as being a comment on a patient's compliance as there are a range of completely valid reasons for which a patient might be wary of institutional staff, or might be reluctant to engage in treatment (eg. past history of coercive treatment or abuse).

Would you like to consider administering the PANSS, PHQ 9, Beck inventory...of course the measurement used would need to be standarised and appropriate to the diagnosis. (The "standarised remission criteria in schizophrenia" mentioned in the previous answers was helpful reading.) It would be useful if used at admission ( to the hospital) and discharge and perhaps other predetermined intervals.  The need for  cross cultural measurement validity should be a consideration  depending on your patient population.

There is infinite appeal in using objective data, such as rates of rehospitalisation, use of emergency services, keeping employment or independent living situations, compliance with provisional discharge contracts (from commitments). What I would wish for, however, would be the tracking of every patient's individual quality of life indicators- obviously subjective.

Long term follow-up is a ongoing concern. It seems that ensuring patient engagement in the treatment plan and goal setting, establishing and maintaining therapeutic environments and relationships are largely left to community based providers. Motivation and education are essential to compliance with treatment recommendations, minimizing the for subsequent. re- hospitalizations.  Unless this engagement happens,  the patient is likely to feel safer away from "the system", and use (or mis-use)  it for emergencies only.

(After hospitalization plans should include considerations such as cognitive changes, illiteracy, substance abuse... . All too often, the patient does not even make it to their first follow-up appointment after hospitalisation: so there is much room for improvement.)

- Material, economic, emotional and cultural poverty

- Violence and abuse in childhood

- Aggressive family means, alcohol or drugs

- Dysfunctional and disorganized Families

- War, violence and sexual abuse Victims

East Central Regional Hospital (ECRH is a state mental health and forensic mental health hospital in Georgia that has been serving the region since 1969 (DBHDD, nda.). The hospital is part of the Division of Behavioral Health that provides inpatient behavioral health services and specialty treatment in the community for sustained support. The DBHDD is known as Georgia’s safety net that serves the uninsured, those on medicaid, and others with minimal resources (DBHDD, nda.). ECRH’s mission is “to be a center of excellence in the provision of comprehensive, responsive and compassionate care for individuals and their families” and the vision for the facility is “To provide safe, competent and compassionate services to persons with mental illness and/or developmental disabilities” (DBHDD, nda.)

As a state facility, certain patient outcomes are tracked, analyzed and compared to national metrics. DBHDD utilizes the Statewide Clinical Oversight program to aid in the care of individuals with intellectual and developmental disabilities to identify risks and improve monitoring of individuals with complex medical and behavioral needs. Categories of heightened risk include health, behavioral, and environmental (DBHDD, 2019). Health related outcomes include emergency room visits and hospitalizations, dehydration, seizures, aspiration, or recurrent serious illness without resolution (DBHDD, 2019). Behavioral outcomes may include cognitive or functional decline, behavioral incidents requiring law enforcement intervention, or significant changes in patient behavior (DBHDD, 2019). Monitored environmental risks include staff training or suitability with individual, loss of a family member who is a primary caretaker, and potential or actual discharge from a residential provider (DBHDD, 2019). The most commonly measured outcomes at DBHDD includes behavioral risks, seizures, bowel obstruction,and inpatient or emergency department visits (DBHDD, 2019).

Georgia Department of Behavioral Health and Developmental Disabilities. (2019) Risk, rates, and resolution of events for individuals with complex needs. Retrieved from https://dbhdd.georgia.gov/organization/be-informed/reports-performance/risk-rates-and-resolution