Pension-Level Supported Residential Services and their Influence in the Occupational Participation and Recovery of Residents with Mental Illness

A Supported Residential Service (SRS) is a privately owned, government regulated housing facility. Initially recognised as supported accommodation services for an older population, Census trends indicate that pension‐level facilities are increasingly more likely to house residents who are male, younger, and with psychiatric, intellectual, acquired brain injury, or drug/alcohol disabilities. The purpose of this research was to understand how the elements of the physical, social and cultural environment impact occupational participation and recovery for residents with mental illness to better inform policy and service provision. A mixed method research design was chosen to provide a comprehensive analysis of the research question. The Residential Environment Impact Scale Version (REIS) 3.0 was the research tool used to assess the residential environment and determine the impact of the environment on the residents. Convenience samples of three SRS’s were included, with a total of 22 resident and staff participants interviewed and observed. Quantitative data was generated by the REIS four point rating scale and scores were compared and contrasted to establish if there were common or different domains that the three SRS’s performed well or poorly in. Descriptive data was analysed for themes. Four themes emerged during this process; opportunities for occupational participation, impact of the social environment, opportunities for self-determination and the impact of political and economic environmental factors. These themes reinforced the domains identified from the raw data ratings and helped establish that residents shared similar experiences of enjoyment, stimulation, boredom, time use and goal setting.
   Similar qualities attributed to institutional environments were found. There was a lack of opportunity for occupation due to; the few objects in the environment, regulations prohibiting participation and staff prioritising care needs that created time constraints impacting residents’ opportunities for independence and participation. Residents’ time use was dominated by waiting, eating and smoking. Days were not experienced as meaningful, rather, the occupations were reported and observed to be a way of filling in the day. The three SRS’s rated well in the domains of physical space and peer relationships, suggesting these aspects of the environment were enabling however they rated poorly in the domains of occupational participation, social environment related to interactions with staff, and level of assistance offered and self-determination. It was these aspects of the environment that predominantly constrained residents’ occupational participation, and are the areas requiring the greatest attention for improvement.
   This study emphasises the influence of the physical, social and political environment on occupational participation and recovery for residents of pension-level SRS’s with mental illness. Overall the pension-level SRS environment was assessed as a significant negative influence in the residents’ quality of life that could be argued as having a predominantly detrimental effect on the opportunity to regain independence, recover and improve health outcomes for this population. A number of key recommendations for the pension-level SRS sector are proposed so future service provision can be in accordance with recovery orientated service principles, and that the political, economic and environmental influences in this sector support participation in occupation for residents.