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Characteristics, diagnosis, need for care, GAF score, and admission patterns were obtained for a group of patients (n 48) who were heavy users of a psychiatric hospital. The need for care was measured with the Camberwell assessment of need. More than half of the patients had a diagnosis of schizophrenia. The second most common diagnosis was personality disorder. Mean age was 37.5 years. Median number of need for care was 11 according to the patients and 12 according to the staff. Overall, the results showed very heterogeneous patterns with regard to age, disability, need for care, and admission patterns. This could indicate that the mental health services should become more differentiated and flexible owing to the presence of a heterogeneous, long-term patient population. Individual needs assessment and treatment programs tailored the single long-term patient are necessary. [ABSTRACT FROM AUTHOR]

A distinct group–the difficult-to-place patients–has appeared in connection with the reorganization process in psychiatry. There is no exact definition of this group, and only a few studies describe the patients in detail. The present study describes the characteristics, admission patterns, and need for care of a group of difficult-to-place patients in Roskilde County, Denmark. The patients were a sociodemographically marginalized group. Most of them were schizophrenics, and two-thirds had a dual diagnosis of alcohol or drug abuse. These patients functioned poorly and had a great need for care and help. As assessed with the CAN, the staff found a greater need for care compared with the patients' assessments with regard to the psychiatric disease, substance abuse, self-care, and problem behaviours. It is our hypothesis that it is the great number of needs in various domains–that is, the severe disabilities in addition to the patients' lack of insight into their need for care, problem behaviour, and alcohol and illicit drug abuse–that make these patients difficult to place in the community. But to be difficult to place in the community is not only something embedded in the patient alone. If relevant services were established, the term “difficult to place” might be changed to “severely disabled” psychiatric patients. [ABSTRACT FROM AUTHOR]