A survey of new long-stay hospital patients in an Irish health board area

New long-stay patients — two years later

Objectives: The aims of this study were to review the outcome of those long-stay patients two years after identification and to compare those discharged with those remaining in hospital in order to identify factors which might contribute to their continuing stay.

Methods: All the new long-stay patients who were more than one year and less than six years on 1st March 1992 were included in the study. Their current placement. Legal status and demographic and clinical details were recorded. Findings: Sixtynine percent of the original cohort remained in hospital, 9% had died, and 22 % had been discharged, mainly to highly staffed accommodation. Approximately half of those remaining in hospital were considered suitable for community placement. Those remaining in hospital were older, had longer durations of illness and were more likely to be dangerous than those discharged.

Conclusions: Despite continuing developments in community services a considerable number of new long-stay patients still remain in hospital and the proportion of those compulsorily detained remains unchanged.

Factors associated with discharge of long-term inpatients with schizophrenia in Japan: a retrospective study

Deinstitutionalization for people with mental disorders has only begun to be implemented in Japan. The purpose of this retrospective study was to examine factors associated with discharge for long-term patients with schizophrenia. Seventy patients were judged capable of discharge with psychiatric rehabilitation (special staff service). As a result of rehabilitation efforts, 37 patients were discharged and 33 patients remained in the hospital. Significant differences were found in age, level of family agreement about patient's disability, and length of the special staff service. These factors might be important to predict patients' potential for discharge.

An audit of new long-stay patients in Irish psychiatric inpatient services

OBJECTIVES

The most recent census of psychiatric inpatients (Daly and Walsh, 2006) examined the decline of the long-stay population (both new and old long-stay) from 1963 to 2006. The aim of the present study was to identify new long-stay patients (patients in hospital between one and five years) in the 2006 psychiatric in-patient census and follow them up one year later to determine the number remaining as inpatients, ie. not having been discharged Methods: New long-stay patients were extracted from the 2006 psychiatric inpatient census data base and were followed up one year later.

RESULTS

Sixty-eight per cent (315/460) of new longstay patients on 31/03/06 were still resident in units and hospitals one year later on 31/03/07, the majority in psychiatric hospitals Forty-two per cent (133/315) of patients had a primary diagnosis of schizophrenia, 13% (40/315) of depressive disorder, 11% (33/315) of organic mental disorder and 8% of intellectual disability (24/315). The number of new long-stay patients discharged or who died showed a sharp decline on previous years.

CONCLUSIONS

Unless current services are improved and extended as advocated in A Vision for Change, it will be a number of years before this population leaves psychiatric hospitals and such hospitals can close because of the lack of suitable alternatives. In accordance with policy recommendations, the continuing requirement for the development of specialised rehabilitation services to cater for the broad needs of those who remain in psychiatric hospitals is of the utmost importance.

Impact of a rehabilitation legislation on the survival in the community of long-term patients discharged from psychiatric hospitals in Israel

BACKGROUND

The aim of the present study was to examine the impact of the Rehabilitation Law 2000 in Israel (which provides a basket of rehabilitation services for every mentally disabled patient) on the survival in the community of a population of long-stay psychiatric patients released from psychiatric hospitals.

METHODS

A naturalistic follow-up study was performed on long-stay patients discharged ("key discharge") from two Israel psychiatric hospitals closed before (in 1997) and after (in 2000) introduction of the Rehabilitation Law 2000. The data source was the National Psychiatric Hospitalization Registry.

RESULTS

The study population consisted of 611 patients. The percentage of patients who, at closure of hospital, were discharged directly into the community was eightfold higher following the Rehabilitation Law 2000 than before. There was also a trend for a lower readmission rate for those patients who were discharged into the community in the post-law period, both for those whose key discharge was directly to the community and for those who were later discharged after being transferred to another hospital at key discharge. Concerning the mean duration of inpatient stay, there was no difference between the two cohorts, whether hospitalizations followed transfer to another hospital from key discharge or rehospitalization from the community. Interestingly, the Rehabilitation Law did not have a significant effect on patients' mortality after key discharge.

CONCLUSION

The Rehabilitation Law 2000 has a beneficial effect on the opportunities of long-stay psychiatric patients to resettle in the community without increasing risk of death.

The new long stay in an inner city service: a tale of two cohorts

We assessed the long-stay inpatients (length of stay > 6 months) from a deprived inner-city catchment area with a population of 210,000 in 1993 and 1995 on a variety of measures, following up both cohorts after 24 months. Total numbers of long-stay inpatients were reduced from 56 (26.7 per 100,000 total population) to 35 (16.7 per 100,000) between 1993 and 1995, in line with the closure of dedicated long-stay beds. The 1995 cohort were more symptomatic according to the BPRS (t = 2.8, p = 0.007, 95% confidence interval 18.1, 3.0), more commonly detained under the Mental Health Act (chi 2 = 6.07 p = 0.05) and more commonly from an ethnic minority (chi 2 = 3.7 p = 0.05). At 2 year follow-up 57% of the 1993 cohort were living out of hospital, compared with 60% of the 1995 cohort. Patients were discharged to a variety of settings, some highly supported. For the combined sample the presence of certain challenging behaviours (absconding, disturbance at night, noncompliance with treatment and violence) predicted continuing inpatient status as did three items on the Social Behaviour Schedule (bizarre behaviour, laughing to oneself and violence). Only five (9%) of the original sample remained inpatients for the entire four year follow-up.

Where to? A survey of the residual population of a district mental hospital and their predicted placement needs

Objective: In line with Irish government and health board policy, existing district psychiatric hospitals are scheduled for rundown and closure, with ongoing care being transferred to general hospitals and community based resources. However it is unclear as to what resources will be required if this policy is to proceed. The objective of this study is to obtain the current needs profile of the inpatient population of one such hospital and to predict what facilities would be needed in the event of closure.

Method: Using a staff completed questionnaire, specially constructed by the hospital rehabilitation team, and which has been used to help predict needs for past successful relocations, information was obtained on all inpatients on a designated day. Each patient was rated as requiring independent, low-support, or high-support accommodation, the nature of which depending on the perceived needs.

Results: This survey shows that the residual population is predominantly middle-aged and elderly with many disabilities and persisting challenging behaviours. The majority have high dependency needs which limits the placements options to high support facilities, which as yet are under provided for in the community.

Conclusion: Further planning and resources will be required if the above policy is to be realised.

Characteristics of the new long-stay population in an inner Melbourne acute psychiatric hospital

OBJECTIVE

There has been an accumulation of so-called 'new long-stay' (NLS) patients in psychiatric hospitals. To date, no Australian studies have characterised this patient group. We aimed to study the demography, and clinical and social functioning of the NLS population at Royal Park Hospital (RPH) together with patients' attitudes to treatment and views on future placement.

METHOD

All 30 NLS patients at RPH were identified. Twenty-seven consenting patients were assessed using the following standardised instruments: Manchester Scale for psychopathology, Life Skills Profile (LSP), Physical Health Index and Patient Attitude Questionnaire. Information on past psychiatric history, past treatment and current treatment was collected. Insight and compliance were assessed.

RESULTS

The majority of patients were single men with a diagnosis of schizophrenia. Forty-one percent were detained in hospital involuntarily and 56% were considered dangerous to themselves or others. The patients were characterised by high levels of positive and negative symptoms. They were most impaired with respect to 'social contact' relative to the other subscales of the LSP. While 10 (48%) patients expressed a desire to leave hospital, only one patient considered that anyone would cohabit with them. Over two-thirds considered they had been unwell and that medication had helped. Staff rated one-third as having major problems with compliance. About two-thirds of patients had disability secondary to comorbid physical illnesses.

CONCLUSION

Like other NLS patients studied in the United Kingdom and Ireland, this group had significant handicaps secondary to psychiatric illness, concomitant physical illness and disability and behaviour unacceptable in community settings. They were also characterised by significant social isolation. These factors may be important determinants of rehabilitation failure and need to be addressed in the process of de-institutionalisation as well as in longitudinal studies examining these and other factors predicting NLS status.