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Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community

TAPS Project 44

Chase Farm Hospital, Enfield

JULIAN LEFF, FRCPsych

Institute of Psychiatry, London, UK

Correspondence: Professor Julian Leff, Head of Social Psychiatry Section, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Declaration of interest None.

Funding from the Department of Health, North Thames Regional Health Authority, and the Sainsbury Family Trusts.

Background Whereas the majority of long-stay in-patients have been successfully resettled in the community, there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes.

Aims To study the long-term outcome of a group of 72 long-stay psychiatric inpatients, regarded as unsuitable for community placement.

Method A prospective cohort study with follow-ups at 1 year and 5 years.

Results The patients' mental state remained unchanged after 1 year and 5 years. The level of functioning and social behaviour showed minimal change after 1 year, but then improved over the next 4 years. The profile of problematic behaviours changed significantly over 5 years, with a reduction of 50% in their frequency. Physical aggression practically disappeared. The improvements in behaviour enabled 29 patients (40% of the study group) finally to be resettled in various care homes, gaining better access to community amenities and living more independently.

Conclusions A high proportion of patients with severe disabilities, designated as ‘difficult to place’ in the community, could benefit from slow-stream rehabilitation within specialised facilities, enabling them to move into ordinary community homes.

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