A Smart Apartment for Psychiatric Inpatients

People with a serious mental illness such as schizophrenia are often cognitively impaired and hence commonly disabled in their functioning, such as in their daily living. Smart technology supports the able functioning of other populations with cognitive impairment—people with dementia, for example. There has been limited study of using smart technology to help people with schizophrenia. This report describes a year-long project that focused on psychiatric inpatients; because of their cognitive impairments, discharge of these patients into the community was difficult.

A convenience sample consisted of eight inpatients diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders as having schizophrenia or schizoaffective disorder. Their mental health care team reported that these patients have difficulty in independent living. This study, conducted between September 2009 and September 2010, involved providing cognitive remediation via smart technology in a live-in apartment at a Canadian tertiary mental health care center. Each participant lived alone for up to one month in the apartment and engaged in daily living activities such as cooking, cleaning, and socializing. The participants also received care as usual; smart technology assisted patients in keeping appointments, and staff interacted with patients face to face via the smart link within the patients' apartments.

The smart technology consisted of two video-linked computers, one in the patient's apartment and one in the unit nursing station, for individualized compensatory cognitive remediation interventions, such as checking in with staff each day to explore well-being and to monitor and prompt for daily living activities, such as medication adherence and cooking.

Evaluation consisted of baseline and end-of-intervention measures, including standardized cognitive testing at both time points, semistructured follow-up interviews with each participant after the intervention, and quarterly focus groups with a convenience sample of seven involved clinical staff. The qualitative data revealed three major themes—the apartment experience, the technology, and learning to live on one's own. Patients saw the apartment as an opportunity for them to experience living on their own, with the support of the inpatient clinical team. It gave patients a sense of privacy that was not possible on the inpatient unit. It provided a place to build confidence in advance of discharge and a place to socialize with families and friends. The smart technology provided an interface with clinical staff that allowed for contact when the patient felt the need for it and for providing skill building and cognitive remediation assistance.

Learning to live on one's own addressed the importance of preparation for community living, which one patient explained thus: “It won't be as scary … to try living on my own again … because I'm familiar with everything I need to do to live on my own. And I did it in a safe setting; I could always go back to the ward if I needed to. I know for sure I'm ready to get out of the hospital now.”

The quantitative analysis of preintervention and postintervention results showed a moderate improvement but did not reach statistical significance. Overall, the results of this project were promising. Our research group is conducting more research, with larger samples and controls, of smart technology for psychiatric patients. We are exploring the use of handheld devices in the community, and there are plans for a smart apartment in a new facility that our health care organization is in the process of building.