Sub-acute residential services are a recent addition to the range of services available to assist people in their recovery from serious mental illness.  One such service is the Adult Step-up Step-down program in Canberra, Australia, which accepts admissions from people entering directly from their home as an alternative to hospital (step-up), or as a transitional step before returning to living in the community after a hospital admission (step-down).  The 5-bed unit has 24-hour staffing, and provides a range of psychosocial therapy groups and opportunities to engage with community groups.

An independent evaluation of the Step-up Step-down service was recently performed, with a range of measures used to assess the effectiveness of the unit as a recovery environment.  Over a 30-month period, all clients were invited to participate in the evaluation and 41 clients consented to be involved.  Improvements in symptoms and functioning were assessed from the perspective of clients (Basis-32) and staff (HoNOS; LSP-16), and the recovery environment with the Recovery Enhancing Environment Measure (REEM).

Both step-up and step-down clients reported improvements in their level of depression, anxiety and psychosis symptoms, and in their relation to self and others, daily living and role functioning.  Staff reported improvements for both client groups in their level of symptoms and self-care, and, additionally for step-up clients, in their level of social problems.

Responses to the REEM indicated that clients and staff felt the service was performing well in each of the 24 recovery elements assessed and was a positive recovery environment.  Although the majority of responses by clients and staff were similar, step-down clients indicated they felt the service could improve in the element of ‘meeting basic needs’, compared to staff responses.

The findings of the independent evaluation provided the Step-up Step-down service with evidence of their effectiveness in assisting clients in their recovery.  The evaluation identified strengths of the recovery-based service and areas in which it could improve, as it continued to focus on meeting the individual needs of their clients.  The findings also provided support for the role of sub-acute residential services for some people, as an alternative to inpatient admission.

Kerry Thomas PhD
University of Canberra