Am J Psychiatry 1996; 153:1318-1324
Copyright © 1996 by American Psychiatric Association
Team for the Assessment of Psychiatric Services (TAPS) Project 33: prospective follow-up study of long-stay patients discharged from two psychiatric hospitals
J Leff, N Trieman and C Gooch
TAPS Research Unit, London, UK.
OBJECTIVE: The purpose of this study was to evaluate the policy of closing
psychiatric hospitals and replacing their functions with community-based
services. METHOD: All long-stay nondemented patients in two U.K. hospitals
scheduled for closure were assessed with a series of schedules. All
patients in one hospital and a proportion of those in the other hospital
were reassessed 1 year after discharge to community facilities. RESULTS: Of
the 737 patients discharged from the two hospitals, 24 died before
follow-up, two by suicide. Follow-up was successful for 94.6% of the
survivors. Only seven patients were lost to follow-up and are presumed to
have become homeless. Only two patients went to prison, one briefly. There
was very little change in patients' psychiatric symptoms or social behavior
problems. The community homes provided a much less restrictive environment
than the hospital wards. Discharged patients were very appreciative of
their increased freedom, and over 80% wished to stay in their community
homes. There was an increase in the proportion of patients with
incontinence and immobility. The patients' social lives were enriched by an
increase in friends, and some made contact with neighbors and others in the
community. However, there was a decrease in contact with relatives
following discharge. CONCLUSIONS: When the capital and revenue resources of
a psychiatric hospital are reinvested in community services, based on
staffed houses, there are few problems with crime or homelessness. With
such well-resourced services, the benefits greatly outweigh the
disadvantages for both old and new long-stay patients.
