Assisted living for mentally ill—a systematic literature review and its recommendations

Abstract

Background

The reduction in psychiatric hospital beds in the past decades has created a need for assisted living (AL). Even though AL is widely used, studies on it are scarce.

Aims

To identify (1) study characteristics of the reviewed articles, (2) characteristics of inhabitants and characteristics of different types of AL, (3) financial costs in different types of AL, (4) the individual outcomes in AL inhabitants and quality of care.

Methods

A systematic literature review on AL for the mentally ill focusing on inhabitant and AL features and their costs was conducted. Articles written in English from January 2000 to June of 2020, concerning adults were included. Simple Taxonomy of Supported Housing (STAX-SA) was applied and used for categorizing types of AL.

Results

Twenty-five papers met our criteria. The majority of inhabitants were unemployed single male with psychotic disorders. The type of AL is mainly categorized according to staffing, provided support, and housing arrangement. In UK ALs with moderate support (STAX-SA 2–3) had the best quality of care while ALs with low support (STAX-SA 4) was the cheapest. Quality of care was better in small units with preset expected length of stay for inhabitants. Hospital treatment was significantly more expensive than any type of AL. Living in AL improved quality of life compared to hospital treatment, also psychiatric symptoms were reduced.

Conclusion

There is an evident need for evidence-based studies in a longitudinal comprehensive manner that evaluates different AL types, function of the inhabitants, and costs with respect to the quality of AL and care and outcome.

Keywords:

• Assisted living
• supported housing
• mental illness
• cost
• outcome

Acknowledgements

This paper received no funds. We would like to thank Oulu University library department for their help in conducting the literature search.

Disclosure statement

E.J. has received compensation from Merck for Podcast recordings, travel expenses from Duodecim, compensation from Finnish Medical Association for hosting events, and is a co-owner in Coronaria Psykiatria Oy.

Additional information

Notes on contributors

Joel Ketola

Joel Ketola, M.D., B.Sc. in Economics and Business Administration.

Erfan Jahangiri

Erfan Jahangiri, M.D., Ph.D. student at the University of Oulu.

Helinä Hakko

Helinä Hakko, Ph.D., Biostatistician at Oulu University Hospital, Department of Psychiatry.

Pirkko Riipinen

Pirkko Riipinen, M.D., Ph.D., Professor of Psychiatry at the University of Oulu.

Sami Räsänen

Sami Räsänen, M.D., Ph.D., Professor of Psychiatry at the University of Oulu.