CHDR FUNDED PILOT STUDIES

Post-Discharge Needs of African American Patients with Mental Illness

Linda Gerson, PhD, RN (JHUSON)
Linda Rose, PhD, RN (JHUSON)
Helen Spriggs, MPH, MSN (NCA&TSON)

African Americans (AA) with mental illness are less likely to receive care for mental illness and more likely to receive poor quality care than their White counterparts (Surgeon's General's report). When they are treated, they are more likely than Whites to be re-hospitalized within a year of discharge from a psychiatric hospital.

Reasons for this more rapid relapse are unclear, but may be related to stressors associated with re-entry to the community after intensive inpatient treatment, fewer resources to deal with health problems; and inadequate follow-up care. The immediate post-discharge phase of treatment may be crucial to long term adaptation to the community.

The specific aims of this study are to: 1) develop a profile of the health status and functioning of AA mentally ill patients in the immediate post-discharge phase; 2) identify mental health needs and problems experienced by AA with SMI in the immediate post-discharge period; 3) test the feasibility of using the MEMS system of monitoring medication adherence in AA's with SMI; and 4) assess satisfaction with care of AA patients and their families.

Data will be collected on patients' functional assessment, positive and negative symptoms, and satisfaction with care. Patients and families will be interviewed about the occurrence of: specific concerns related to mental illness, health concerns not related to mental illness, contacts with health providers, and treatment (medication) adherence. We are hypothesizing that the successful management of the illnesses in these first few weeks will influence the long term success of patients to manage their illnesses.

Data from this preliminary study will provide important information about the post-discharge needs of a vulnerable population and will be used to develop a large scale clinical trial of a nurse led home based transitional care intervention for recently discharged SMI patients. The study will also provide important insights into the feasibility, effectiveness and cultural relevance of the data collection instruments. This pilot study is an important first step in a program of research targeted as addressing those health disparities.