Outcomes for Long-Term Patients One Year After Discharge From a Psychiatric Hospital

Health Services Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
Psychiatric Services (Impact Factor: 2.41). 12/2005; 56(11):1416-22. DOI: 10.1176/
Source: PubMed


The purpose of this study was to evaluate effects associated with moving patients from hospital to community-based settings, to compare persons who left the hospital with those who remained in the hospital, and to address the question of whether discharge reverses institutionalism in a sample of elderly long-stay psychiatric inpatients.
The hypotheses were that, compared with the control group of patients who stayed in the hospital, those who left would have significantly better mental states, social functioning, and social networks at follow-up; that community settings would provide a significantly better quality of environment than the hospital; and that discharged patients would express a preference for community care after discharge from the hospital. The study was a prospective nonrandomized controlled trial at Cane Hill, Friern, and Claybury Hospitals in England. Sixty long-term patients with schizophrenia who were discharged to community care were compared over time with matched controls (N=131).
No overall differences were detected in the pattern or severity of symptoms between patients who were discharged from the hospital and those who were not, and no significant changes over time were noted. Significant improvements in social networks, patients' preference for community settings, and quality of clinical environment were noted.
These results give qualified support for moving long-stay psychiatric patients from hospital to community settings.

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    • "One survey showed that in most parts of the UK, rehabilitation services continue to provide short-to medium-term 24-hour nursed care units supporting new long-stay patients (Killaspy 2005). Outcomes for previous long-stay patients moved into community placements have generally improved; they are more satisfied, have better social functioning and costs are no greater than those in hospital – in many cases they are rather less (Trieman 2002; Thornicroft 2005). Asylums have been replaced by a complex network of community services, including a 'virtual asylum' of residential and nursing home provision (Holloway 2008). "
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    • "According to this approach, the hospitalization period is intended for treatment of the acute phase of the mental illness and not for a prolonged stay. After the acute phase, efforts should be made to enable the disabled person to return as soon as possible to a normal and routine course of life and be integrated in the society [4-6]. All studies point to the fact that the wider the range of rehabilitation services provided to people with mental disabilities, the sooner and greater the improvement in their functioning [1,7,8]. "
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