Residential care for mentally ill people in Andalusia and London - a comparison of care environments, users' attitudes and cost of care

Background: This collaborative study evaluates newly developed residential facilities in Andalusia and compares them with the established care network in London. Aims: The study aims to discover the similarities and differences in the quality and effectiveness of residential care provision in the two regions. Method: A comparative study of matched samples, comprising 136 former long-stay psychiatric patients living in 30 community facilities in Andalusia and London. Domains explored included: the demographic and social profiles of residents, objective measures of care environments, cost of residential care and attitudes of service users. Residents and facilities were assessed, using a batch of cross-translated schedules with established psychometric properties. A cost related analysis was conducted using the Client Service Receipt Interview (CSRI). Results: While residents in both locations are equally disabled the level of support is significantly higher in London than in Andalusia. The Andalusian facilities are more restrictive in management policies, offering less privacy to their residents. A higher proportion of staff in Andalusia are professionally qualified, but the training opportunities for British staff are greater. Both British and Andalusian residents prefer living in the community. The average cost of residential care is markedly higher in London than in Andalusia. Conclusions: There is a need to extend the network of residential facilities in Andalusia and apply less restrictive policies. The cost-effectiveness of staffed group homes should be scrutinised and professionalism among British residential staff increased.