Objectives-To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified.Design Main outcome measures-Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview.Results-89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accommodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months).Conclusions-Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands ofthose with less severe illness. IntroductionPolicies of closing large mental hospitals and reproviding for patients in the community were adopted in Britain over three decades ago, yet few data have emerged on the workings of replacement services.' Recent studies of resettlement projects for long stay hospital patients have reported somie success,25 yet much evidence points to mentally ill people, especially people with schizophrenia,6 being homeless,78 in poverty, or imprisoned.9 Consequently, misgivings about the everyday effectiveness ofservices in caring for both long stay and shorter stay patients are continuing to grow both in Britain and the United States.'0 12We documented and quantified the circumstances and care of former inpatients with schizophrenia who had recently been discharged from local psychiatric services in order to establish the extent to which these

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