A community project to encourage compliance with mental health treatment aftercare

Rehospitalization of mentally ill persons has been associated mainly with two major factors, noncompliance with the prescribed course of medication and noncompliance with planned aftercare. The authors developed and pilot tested a community health project designed to assist chronically ill mental health patients who, when discharged from hospital care, are considered at high risk for rehospitalization. The project was designed to support clients' efforts to comply with their prescribed course of aftercare therapy, support, and medication. The project was developed at the University of Maryland at Baltimore, School of Nursing, in cooperation with the U.S. Department of Veterans Affairs. The project consisted of interventions during the critical time after hospital discharge but before the client becomes fully established in outpatient treatment. The interventions were based on the principle of catching the high-risk client before a crisis situation occurred. The four interventions were (a) discharge planning for the individual client that stressed education about the client's psychiatric illness; (b) education about medications prescribed for the client; (c) an education program for family members and others to assist them in helping the individual client; and (d) communicating with the client to reinforce the support network concept, using a 48-hour followup telephone call, an information contact by post-card, and a non crisis telephone line. The project was implemented on a pilot basis during the fall of 1992 by the nursing students and staff members at a major urban Department of Veterans Affairs Medical Center (VAMC). The pilot project involved 31 staff and community health professionals and 68 client interactions during 1992. Data were collected from clients and staff members during and after the project was implemented. The project was evaluated using a multimethod evaluation tool, and revisions were incorporated based on the results.Clients who participated in the program indicated that establishing caring relationships within a support network was the most significant factor in achieving compliance with aftercare. The results of the project, noted by staff members and observers, have led to implementation and expansion of interventions by subsequent groups of nursing students. Plans for the future of the project include determining rates of recidivism and obtaining more information on other health outcomes of clients.