Background The social inclusion of people with intellectual disabilities presents a major challenge to services. As part of a 12-year follow up of people resettled from long-stay hospitals, the size of 213 individuals' social networks and the types of social support they received were investigated, as viewed by people with intellectual disabilities themselves. The types of support received in four different kinds of community accommodation were compared. Method Individuals were interviewed and their social support networks mapped using a Social Network Guide developed for the study. Descriptive statistics were generated and comparisons made using generalized linear modelling. Results The sample comprised 117 men (average age 51 years) and 96 women (average age 56 years). All but seven were White British, 92% were single and they had in general, mild to moderate intellectual disabilities. The average network size was 22 members (range 3-51). The mean density was 0.5. A quarter of all network members were other service users with intellectual disabilities and a further 43% were staff. Only a third of the members were unrelated to learning disability services.In general, the main providers of both emotional and practical support were staff, although these relationships were less likely to be described as reciprocal. Other people with intellectual disabilities were the second most frequent providers of all types of support. People in small group homes, hostels and supported accommodation were significantly more likely to report close and companiable relationships than those in residential and nursing homes, but they also reported a greater proportion of critical behaviour. Conclusions The social networks revealed in this study are considerably larger than those of previous studies which have relied on staff reports, but findings about the generally limited social integration of people with intellectual disabilities are similar. A clearer policy and practice focus on the desirability of a range of different social contexts from which to derive potentially supportive network members is required so that people do not remain segregated in one area of life. Some participants were able to provide membership category but not the type of support provided or interactional behaviours, hence the different totals.

Background The social inclusion of people with intellectual disabilities presents a major challenge to services. As part of a 12-year follow up of people resettled from long-stay hospitals, the size of 213 individuals' social networks and the types of social support they received were investigated, as viewed by people with intellectual disabilities themselves. The types of support received in four different kinds of community accommodation were compared. Method Individuals were interviewed and their social support networks mapped using a Social Network Guide developed for the study. Descriptive statistics were generated and comparisons made using generalized linear modelling. Results The sample comprised 117 men (average age 51 years) and 96 women (average age 56 years). All but seven were White British, 92% were single and they had in general, mild to moderate intellectual disabilities. The average network size was 22 members (range 3-51). The mean density was 0.5. A quarter of all network members were other service users with intellectual disabilities and a further 43% were staff. Only a third of the members were unrelated to learning disability services.In general, the main providers of both emotional and practical support were staff, although these relationships were less likely to be described as reciprocal. Other people with intellectual disabilities were the second most frequent providers of all types of support. People in small group homes, hostels and supported accommodation were significantly more likely to report close and companiable relationships than those in residential and nursing homes, but they also reported a greater proportion of critical behaviour. Conclusions The social networks revealed in this study are considerably larger than those of previous studies which have relied on staff reports, but findings about the generally limited social integration of people with intellectual disabilities are similar. A clearer policy and practice focus on the desirability of a range of different social contexts from which to derive potentially supportive network members is required so that people do not remain segregated in one area of life. Some participants were able to provide membership category but not the type of support provided or interactional behaviours, hence the different totals.

We report service users' views on three important domains of their quality of life in the community 12 years after resettlement for long-stay hospitals. These concerned their living environments, daily activities and future aspirations. We asked a series of open questions as part of a structured interview with service users with learning disabilities (n 5 196) and mental health problems (n 5 102). The study is the longest reported follow-up of deinstitutionalisation in the UK and one of the longest anywhere in the world. The most frequently self-reported positive aspects of users' quality of life were the living environment, the social milieu and independence. The most frequently mentioned problems occurred within the social milieu and included bullying, the social regime, the physical aspects of the accommodation, and the personal feelings of loneliness and boredom. The most preferred activities were outings, education and work, relaxation and leisure. The most disliked activities were household chores and having nothing to do. About half those interviewed did not or could not answer a question about their future; those who did mentioned a wish for greater independence, more outings and personal and sexual relationships. We remark on some implications for services and for staff training.

Appropriate activities and social contexts are still needed to facilitate the social networks of people with mental illness, in particular, for those aged under 65 years.

Background: Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. Aims: To assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and people's characteristics, needs and outcomes. Method: Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative. For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Results: Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (£555 per week) are lower than long-stay hospital residence or community costs 1 year later. Conclusions: High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents' increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs. Declaration of interest: The Department of Health funded the research.