Deinstitutionalization of long‐stay patients with schizophrenia: the 2‐year social and clinical outcome of a comprehensive intervention program in Japan
ABSTRACT Objectives: The Sasagawa Project aimed to investigate the effects of deinstitutionalization and evidence-based strategies for the treatment of mental disorders among long-stay patients after their discharge from a mental hospital using a quasi-experimental longitudinal study design and to assess the patients’ social and clinical outcomes over a 2-year post-discharge period.Method: Seventy-eight patients with schizophrenia were transferred to a community facility (Sasagawa Village) following the closure of Sasagawa Hospital in Koriyama in March 2002. The patients had undergone psychosocial training following the protocol outlined by the Optimal Treatment Project. All evaluations were performed prior to the patients’ discharge and were repeated 12 and 24 months after discharge using the Positive and Negative Syndrome Scales, the Global Assessment for Functioning, the Schedule for Assessment of Insight, the Rehabilitation Evaluation Hall and Baker Scale, the Social Functioning Scale, the Drug Attitude Inventory, and the Mini-Mental State Examination.Results: During the 24-month study period, 18 residents had incidents that made their continued stay at Sasagawa Village impossible. Only four (5.1%) of these residents were readmitted to psychiatric wards because of exacerbations of their conditions. Twelve residents were admitted to hospital because of serious physical illnesses. The 60 residents who remained in the community facility for 2 years demonstrated significant improvements in not only their psychiatric symptoms, but also their social functioning, as evidenced by their scores for Social Activity, Speech Skills, Disturbed Speech, Self-Care and General Behaviour on the Rehabilitation Evaluation Hall and Baker Scale and Withdrawal, Independence (Performance), Independence (Competence), and Employment on the Social Functioning Scale.Conclusions: Careful planning that minimized social and clinical dislocation may have contributed to the successful transition from mental hospital to community facility assessed in this study. Patients with a long history of illness showed favourable outcomes with little clinical deterioration and various improvements in their psychiatric symptoms and social functioning.
Article: The effects of nursing discharge plan (post-discharge education and follow-up) on self-care ability in patients with chronic schizophrenia hospitalized in Razi psychiatric Center.[show abstract] [hide abstract]
ABSTRACT: Schizophrenia is a debilitating psychotic disorder that affects patients' personality, career-related and social functioning. Patients stop medications after discharge or inpatient care, when they feel relatively recovered. Most patients do not know that they are sick and they need medication for recovery due to lack of information and cognitive impairment, which makes them incompetent for self-care. A well designed discharge plan with disease management, prevention cares and education along with follow-up can significantly improve patients and decrease the health care costs; because it helps them take care of themselves and maintain a certain level of health. This study aimed to determine the effect of discharge, education and follow-up program on self-care abilities of patients with chronic schizophrenia. This was a quasi-experimental study, using a hospital based accessible sampling method. Participants included 60 schizophrenic patients who were randomly divided into two groups of intervention and control (30 patients in each group). After their symptoms were relatively controlled, the intervention group received a service of post-discharge program and home-care for 6 months. Data were collected before, and one month after education up to 6 month after discharge, using a demographic data questionnaire and a researcher-made questionnaire for self-care. Validity and reliability of instruments were approved by content validity and test-retest, respectively. Also, ethical approval for this study was obtained from the University of Social Welfare and Rehabilitation Science. There was a significant difference between the self-care abilities after intervention (from month 1 to month 6) in the intervention group compared with the controls. It means that conducting a discharge plan, education and follow-up increased the self-care abilities of the participants in the intervention group compared with themselves and control group members. Educating patients and their families and follow-up cares after discharge along with medications led to independency, self-care improvement and cognitive and social functioning of schizophrenic patients.Iranian journal of nursing and midwifery research 01/2011; 16(2):162-8.