BMJ 1999;319:13-16 ( 3 July )

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Outcome of long stay psychiatric patients resettled in the community: prospective cohort study

Noam Trieman, senior lecturer, a Julian Leff, professor of social and cultural psychiatry, a Gyles Glover, senior lecturer. b

a Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London NW3 2PF, b Section of Community Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

Correspondence to: Dr Trieman n.trieman{at}fleet69.demon.co.uk

Objective: To examine the outcome of a population of long stay psychiatric patients resettled in the community.
Design: Prospective study with 5 year follow up.
Setting: Over 140 residential settings in north London.
Subjects: 670 long stay patients from two London hospitals (Friern and Claybury) discharged to the community from 1985 to 1993.
Main outcome measures: Continuity and quality of residential care, readmission to hospital, mortality, crime, and vagrancy.
Results: Of the 523 patients who survived the 5 year follow up period, 469 (89.6%) were living in the community by the end of follow up, 310 (59.2%) in their original community placement. A third (210) of all patients were readmitted at least once. Crime and homelessness presented few problems. Standardised mortality ratios for the group were comparable with those reported for similar populations.
Conclusions: When carefully planned and adequately resourced, community care for long stay psychiatric patients is beneficial to most individuals and has minimal detrimental effects on society.


Key messages

  • Replacing a psychiatric hospital with full residential facilities in the community has worked well for most long stay psychiatric patients

  • Recurrent and sporadic readmissions to hospital are inevitable for high risk patients regardless of their living conditions

  • Fears are unfounded that former hospital inmates are destined to neglect, high mortality, and homelessness, or that they pose a threat to the public




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