The linear continuum of transitional residences: debunking the myth

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 residential option.