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Detailed progress and outcome data for a small group of ‗new long-stay‘ patients living in a ‗ward-ina-house‘ (hospital hostel) were examined. There was no evidence of pre-existing differences related to final outcome. Those residents who were eventually resettled showed more evidence of improvement over the length of their stay, and had significantly better overall functioning in the period immediately prior to their resettlement. The group who were eventually transferred out of the unit showed less evidence of improvement and more evidence of deterioration, albeit commonly following some initial improvement. They also showed an increase in violent and aggressive behaviour in the weeks immediately prior to their move. The ongoing group of current residents appeared to be specifically characterised by significant fluctuations in their functioning over their length of stay. The implications of these findings for the long-term rehabilitation and care of these patients are discussed.

A survey identified old long-stay patients in Ontario provincial psychiatric hospitals (PPHs) who were admitted before age 65, and had been hospitalized continuously for more than 6 years. PPHs serving the sparsely populated north and the Toronto megalopolis were excluded. reported all old long-stay inpatients for September 1, 1993. population were considerably lower than a comparable study in Scotland where occupancy rates were 59 per 100,000. Possible reasons for this difference include rehabilitation programs in Ontario PPHs that address needs of old long-stay patients, and the introduction of community support programs. Occupancy rates of 4.93 per 100,000 Remaining hospitals

This study assesses the effects of relocation from hospital on the level of functioning, morale and satisfaction of 188 long-stay patients discharged from the six major psychiatric hospitals in Northern Ireland during 1990-1992. There was little change in clients' skills (eg. domestic and social skills) one and two years after discharge. The behaviour of former patients was not adversely affected by life in the community. They were less depressed than in hospital and were also more satisfied with their living environments. Overall, the findings, which are broadly in line with those reported elsewhere, indicate that the policy of relocating people outside hospital has been a limited success.

The replacement of long-stay hospital services with community-based care can have considerable resource consequences. How much community care costs and whether it is more expensive than hospital care are questions high on the policy and planning agenda. Decision-makers should also be interested in whether levels of expenditure are associated with clients' needs and with changes in their wellbeing. These questions were addressed in a wide-ranging evaluation of community care in N. Ireland. In examining the costs of accommodation and other services used by former residents of nine hospitals (n=133) the study found community care to be cheaper than hospital care. Broadly speaking, the new service was a cost-effective alternative as little change in clients' welfare was found. However, analysis of the variations in community care costs found only weak associations with clients' personal characteristics and needs, and found no link between differential spending and differential outcomes.

The present study evaluates the progress and outcomes of the first hostel-ward established in this country, sixteen years after its original opening. In this period seventy percent of residents have been discharged, the majority into supported hostel accommodation in the community. Although characteristics of residents admitted to the hostel have remained unchanged over the sixteen year period, the duration of stay of residents before discharge has reduced by almost fifty percent. In terms of long-term outcomes, the second cohort admitted has proved to be more successful than the first. A number of variables were associated with better outcome following discharge. These were: planned discharges to supported hostel accommodation, a diagnosis other than schizophrenia and fewer behavioural problems and higher levels of functioning at discharge. Compared to community-based hostels, fewer patients have been transferred to alternative hospital settings. This hostel-ward has, therefore, been able successfully to...

Despite the move towards care in the community there remain in our psychiatric hospitals long stay patients who have yet to be found places in the community. Below is reported a study in which the impact of shrinking psychiatric hospitals upon these long stay patients was assessed. In terms of psychiatric state and quality of life these patients have declined over the two years since large scale hospital discharge programmes began. Furthermore, the hospital 'stayers' are showing increasingly pessimistic attitudes towards their eventual life in the community. This can only add to the difficulty with which these patients will eventually be integrated into the community.

Eight long-term mentally ill patients who were relocated from Holywell Hospital into a community residential unit were studied for effects on mental state, social functioning, problems and consumer satisfaction. After six months, there was no significant change in mental state, but there was an improvement in the number of problems encountered. Seven of the subjects rated their level of satisfaction at or above the median level.

This paper presents data from the RDP Cane Hill Closure Research Project, which studied the reprovision of a mental hospital in three Health Districts. The process of closure showed significant deviation between initial plans and actual outcome. Overall, the most disabled residents moved into the most highly supported settings, although there were significant differences between Districts. Reprovision projects offered a much improved quality of environment for hospital residents. There was little evidence of change in symptomatology amongst discharged patients, although social functioning did significantly improve in a number of reprovision settings. Whether these, services developed for former long stay hospital residents are relevant for future service users, who are extremely disabled by their illnesses, is open to question.

Two studies were carried out in supported housing projects developed for less disabled residents as part of a mental hospital closure programme. One year after discharge modest improvements in social functioning were found, although there was no significant change in the level of “problem behaviours” amongst residents. A study of the views of residents about leaving hospital indicated that, whilst only a minority had wished to leave, most were glad to have left hospital and few wished to return. Interpersonal difficulties between residents were commoner in low-staffed houses compared with high-staffed houses.

Methodological issues concerned with the conceptualisation and measurement of the quality of life of long-stay psychiatric patients are discussed and the reliability and validity of current methods of assessment are considered. This paper describes the development and implementation of an adapted version of Lehman's quality of life scale with 62 long-stay patients being resettled from hospital. The study reports on the findings from the baseline phase of the study conducted on the hospital wards, and examines the internal reliability of the quality of life indices and their stability over time. The influence of demographic and clinical characteristics on the quality of life data is also examined.

A structured interview was used to predict the support services required by a group of 156 long stay psychiatric inpatients if they were relocated in the community. The majority were considered to require a considerable amount of supervision, though there were clear differences in the type and amount of support which would be required. In spite of its limitations, the information presented by a systematic study is an essential basis for the planning and organisation of alternative care.

A recent visit to Wisconsin, USA, as the guest of Professor Leonard Stein, provided the author with an opportunity for greater understanding of the whole-hearted approach pioneered in Dane County to the care and treatment of people who suffer as a consequence of severe mental illness. Beginning in the 1960's, systematic service developments from the Mendota State Hospital and the University of Wisconsin in Madison have resulted in “the Madison model” that has encouraged a world wide reformation. “The Copernican Revolution” in mental health services occurs when care and treatment are made to revolve around the recipient, instead of requiring the person either to move through revolving doors to obtain help or to be required to live in long stay institutions out of sight and out of mind. Some of the paradoxes and problems in applying this mode of working are discussed.

The resettlement of 15 old-long-stay patients in ‘warden-supervised’ accommodation was evaluated at intervals over a 1 year follow-up period. Subjects were selected for resettlement on criteria that did not include the attainment of specific functioning goals. Apart from one death, all patients were still living successfully in their new accommodation at the end of 1 year. No major changes in mental state or overall functioning occurred, but there was clear evidence of a ‘honeymoon effect’ beginning shortly after resettlement and lasting for around 2 months. By 4 months, functioning had returned to pre-discharge levels, where it remained. Some differences were found in utilisation of time but people's social networks became markedly more ‘normal’. All residents expressed satisfaction with their new accommodation. The implications of the findings for service planning and staffing decisions are considered.