Health care systems are facing challenges because of the ageing global population with severe mental illness. Reports suggest that about 3.4 million adults suffer from serious mental illness, and these numbers are projected to double in the coming couple of decades.

The major questions that need addressal is, how to effectively support older adults living with serious mental illness (SMI)? Researchers from the Department of Psychiatry at New Hampshire conducted a randomised trial to study the long-term outcomes of Integrated Skills Training and Preventive Health Care in older patients. Their findings provide valuable insights into a promising approach known as the HOPES program.

What Is the HOPES Program?

HOPES (Helping Older People Experience Success) is an integrated intervention designed to improve both psychosocial functioning and preventive healthcare engagement among adults aged 50 and older with serious mental illness.

The traditional approaches, like combined cognitive behavioural therapy and social skills training (CBSST) and functional adaptation skills training (FAST), treat mental and physical health separately. HOPES, on the other hand, is a more efficient method that combines:

• Social and life skills training
• Community-based practice activities
• Nurse-led preventive healthcare coordination

This dual approach addresses the real-world challenges older adults face daily.

HOPES Programme structure

HOPES programme consists of 12 months of weekly skill-training classes, twice-monthly community practice trips, and monthly nurse preventive health care visits, followed by a 1-year maintenance phase of monthly sessions that use role-play and real-life simulations. The training session accommodates 8-10 participants who attend two sessions on the same day, a 90-minute morning session focused on a specific skill and a 60-minute afternoon review session to consolidate the selected skill using role-play exercises, with a lunch break in between, encouraging socialization.

1. Skills Training Component

The sessions are organised in seven modules that cover:

• Communication skills
• Building relationships
• Healthy Living
• Taking out Leisure Time
• Medication management
• Navigating healthcare systems
• Regular visits to the Health Care systems

2. Preventive Healthcare Component

This component consists of monthly meetings with a nurse who evaluates patients’ health care needs, which focuses on:

• Health screenings (e.g., vision, hearing, cancer)
• Advance care planning
• Doctor’s visits

3. Maintenance Phase

• Monthly booster sessions during the second year
• Reinforced learned skills and behaviours

4. Usual treatment

Participants continue to receive routine mental health services at all the sites, including:

• Pharmacotherapy
• Individual therapy
• Outreach by non-nurse clinicians
• access to rehabilitation services (eg, groups and psychoeducation)

Outcomes of HOPES Programme

1. Improved Daily Living Skills

Participants in the HOPES program showed significant improvements in independent living skills, and these were persistent even after three years of the programme

2. Increased Self-Efficacy

The participants, particularly suffering from mood disorders, reported confidence in the management of symptoms, handling social situations and living independently.

3. Reduced Psychiatric Symptoms

HOPES intervention lowered negative symptoms, reduced overall psychiatric symptom severity, and showed a trend towards reduced depression.

4. Better Preventive Healthcare Engagement

The participants were more likely to receive preventive healthcare assessments like eye exams, hearing tests, mammograms and PAP smears.

5. Reduced Emergency and Hospital Use

HOPES Participants experienced fewer hospitalizations and reduced emergency room visits. 

Why Participation at HOPES matters?

HOPES programme offers reliable and actionable insights for patients suffering from serious mental health illnesses. The outcomes of the HOPES suggest that combining psychosocial training with healthcare coordination leads to better outcomes than treating the patients separately. The program also trains older adults with practical skill that helps them to remain in the community rather than moving to institutional care.

HOPES programme can thus be a great transformational programme for the ageing adults when supported by the health-care providers, providing structured support like scheduled appointments, reminders, and follow-up, along with transportation assistance. Overall, the program promotes more independent, stable, and healthier living for the aging population.