Ir J Psych Med 2008; 25(4): 157-160 parental consent. It is probable that children from more chaotic backgrounds where drug misuse may be an issue were under-represented in this study.

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The author wishes to point out that for the calculations of the economic cost of illness studies, like study of schizophrenia in Ireland by Behan et al, it is important to report all the inpatient days (bed-days), in the annual reports of HRB.The HRB has consistently not included the bed usage data on patients with stay over one year, as it grossly distorts the calculations on the length of stay. 4 The author wishes to argue about ways to overcome this problem, and is looking for the experts' opinion on the methodology used. (Table 1). 1 This group had an average length of stay of 13,902 days and median 13,066 days. Half of all inpatient days on discharge were accounted for by those with a length of stay of 10 years or more and yet these patients accounted for just 0.5% of all discharges.When all discharges are considered, there were 1,671,411 inpatient days; however the 2 % of discharges excluded from the HRB report accounted for 1,161,566 of these inpatient days, with 9 8 % accounting for 509,845 inpatient days.When inpatient days by hospital type are examined for 2 0 0 8 it can be seen (Table 2) 1 that over 7 3 % of inpatient days on discharge are accounted for by psychiatric hospital discharges (as distinct from general hospital units) which leads us back to our primary concern in the paper Dixit refers to, ie., whether the outcome of our follow-up of the long stay patients one year later would facilitate the closure of the older psychiatric hospitals given that 8 6 % of these patients resided in these psychiatric hospitals. Unfortunately the results were not encouraging in this regard. Hence, this would lead us to conclude that a very small proportion of long-stay patients in psychiatric hospitals are contributing to a huge amount of the total number of inpatient days and impeding the closure of these hospitals in line with policy.In addition, Dr Dixit's letter mentions that 'Thus in-spite of the recommendations and policies slightly over 4 0 % of total inpatient days are due t o , -7 % of total psychiatric inpatients staying at the unit over three months, giving many acute units the feel of long-stay psychiatric ward'. However our study shows that only a minority of long-stay discharges were from general hospital units. Indeed the HRB psychiatric inpatient census in 2 0 0 6 reported that of 785 patients resident in general hospital psychiatric units on 31/03/06, only 32(4%) had been in hospital for more than one year.

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