Community care 'benefits' patients

Many patients are no longer institutionalised in hospitals

Community care has enhanced the quality of life for more than 500 patients discharged from two long-stay psychiatric hospitals, a study has found.

The study, published in the British Journal of Psychiatry, found that after discharge patients gained domestic and social skills and acquired friends and confidants.

Of the 130 psychiatric hospitals operating in England and Wales in 1975, more than 100 have now been closed.

The Team for the Assessment of Psychiatric Services (TAPS) was set up in 1985 to evaluate the transfer of care from psychiatric hospitals to district-based services.

One of TAPS's major projects has been to follow up long-stay non-demented patients discharged from two hospitals.

The TAPS team has now completed a five-year follow-up of the original sample of 670 patients.

The most common psychiatric problem among the patients studied was schizophrenia.

The study found that there was no change over time in social behaviour problems as a whole, or problems related to the negative symptoms of schizophrenia.

Boost to community skills

However, over the five years patients had increased their community skills significantly.

For instance, they had learned how to use public facilities such as the post office, pubs and public transport.

After five years, patients also had better domestic skills such as cleaning and cooking.

They also had more friends and confidantes.

Patients also appeared to have become more confident about living in the community.

While still in hospital, 30% of patients said they wished to remain there, but after five years in the community almost all said they were happy outside the hospital environment.

Almost 85% wanted to remain in the community homes in which they were living, while most of the rest had ambitions to move to a flat of their own. Only a handful said they wanted to go back to hospital.

There was also a significant rise in the proportion of patients who viewed their medication as helpful.

Lead researchers Professor Julian Leff, from the Institute of Psychiatry, and Dr Noam Treiman, from the Royal Free and University College Medical School in London, say that they are "reasonably confident" that the improvements in the patients' quality of life are attributable to their move from hospital, rather simply to the passage of time.

The research follows an Australian study that found schizophrenics treated in the community were no more likely to commit crime than those who had been diagnosed before community care came into force.