A cohort of patients treated in two psychiatric services with differing admission policies was followed-up for two years and the effects of the patients on their families was measured and compared at the beginning and end of the period. All the measures used showed that the community service which favoured extra-mural care left the patient's families more heavily burdened.
However, this did not apply when those families whose patients had been the most severe burden at referral were considered separately. These families were helped equally in both services even though significantly fewer patients were admitted in the community one. Similarly, the families of all patients over 65 years and of all patients who were never admitted to hospital were not adversely affected to a significantly greater extent in the community care service after two years, although there was an unmistakable trend in that direction.
When the differences between the services in family burden was examined in more detail, the higher ratings obtained in the community service were found to be due to the effects on the family of a discrete group of patients. These were the younger, mainly psychoneurotic, patients who had had at least one admission and who had never been a severe burden, but who continued to cause their families problems after two years. The community service was not providing as much social support to the families of this group as was the control service.