OBJECTIVE: After defining the transitional residence in the linear
continuum of possible residential settings for recipients of psychiatric
services, the authors address the question of whether this continuum
functions as designed. Do persons with serious and persistent mental
illness really enter the continuum in a more restrictive setting than that
from which they emerge after a period of years and a number of transitions?
METHOD: The authors surveyed all residential placements in western
Massachusetts at one point in time in 1987 and again in 1991. The data
included when a mentally ill individual entered a residential setting and
what his or her prior setting was. Further, in 1991 the authors collected
data on where the subjects of the 1987 study were currently living.
RESULTS: In both the 1987 and the 1991 studies, 70%-75% of all beds were
occupied by persons who had come directly from the state hospital, and only
5%-6% of beds were occupied by persons who had moved from a more
restrictive to a less restrictive setting. In 1991 49.1% of the 1987 study
subjects were in programs with the same level of restrictiveness, 7.9% were
in less restrictive residential programs, and 31.8% were in less
restrictive settings that included independent living. CONCLUSIONS: The
transitional residence in the linear continuum does not function as
designed for the majority of patients discharged into this system of care.
It is premature to abandon it totally, however; it should become part of a
set of community residential alternatives rather than be the only community