Determinants of recovery among clients of the comprehensive, recovery-oriented community mental health system

Objectives: Several states have recently put in place comprehensive, recovery-oriented, community-level models of mental health care. This study aimed to identify an individual's characteristics that modify chances of achieving recovery among participants in the Full-Service Partnerships (FSP), California's comprehensive county mental health program. Methods: Using data from the FSP programs on 9,208 individuals aged 18 or older from 2005 to 2009, this study estimated Markov models of bi-weekly residential transitions among nine residence statuses including living independently in the community, being homeless, and being in jail. Transition probabilities were parameterized with socio-demographic characteristics, DSM-IV diagnoses of mental disorders and substance abuse, and dichotomous continuous program participation. Independent community living was considered as achieving recovery status. Results: Greater age was a significant predictor of independent community living, and reduced jail use (p < 0.01). Compared to whites, nonwhites were more frequently found to be homeless and use jail (p < 0.01). Gender and education levels had no independent effect on residential movements. Persons with schizophrenia were the least likely to have the independent living status, followed by persons with bipolar disorders (p < 0.01). Substance abuse significantly reduced the likelihood of independent living and increased chances of being homeless and using jail (p < 0.01). Continuous program participation significantly increased the likelihood of independent living (p < 0.01). Conclusions: Younger age, being nonwhite, severe mental disorders, and substance abuse reduce the likelihood of independent living among participants of comprehensive, recovery-oriented community mental health programs. Continuous program participation appears promising.