Community care for patients with schizophrenia one year after hospital discharge.

Abstract

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

The social adjustment of people with severe mental illness in São Paulo, Brazil

“…1-4 Melzer et al, 26 in a 1-year follow-up study of schizophrenic patients discharged from psychiatric hospitals in London, found that at follow-up 29% of the sample had good or excellent social adjustment, 50% had fair or poor, and 22% had very poor social adjustment or severe disability. Four years later, 41% were in the intermediate group, 41% showed good levels of social adjustment, and 18% had severe disabilities.…”

A Historical Perspective of Treatment and Discharge Planning for the Seriously, Chronically, Mentally Ill Patient: A Review of the Literature

“…Patients reported positive attitudes toward short hospitalizations and community resources, citing beneficial gains from treatment, activities, staff interaction, a safe environment, improved insight into their condition, and opportunities for selfimprovement. In contrast, other patients reported that the available community resources and services were of such low quality, they were better off not using them (Melzer et al [15]). …”

“…Associating the symptoms with a learned behavior, however, increased patient active participation in learning about behavioral adjustment. The patient had an active role in the future, rather being a Gruenberg et al [12] and Melzer et al [15] discussed individualized care. Chronic patients, especially those with highest need, underused the available community resources.…”

“…The introduction of neuroleptic drugs, outpatient medication administration, and long-acting injectable medications also played an important role, gradually replacing formal E.C.T, insulin coma, and leucotomy treatments. Group therapies were introduced during this time period, as part of the treatment options [13][14][15][16][17][18][19][20][21][22][23].…”

Social justice, human rights and mental illness

“…2 4 They also tend to experience obstacles accessing community care services following discharge from hospital 5 and have particular difficulties with re-integration into society. 6 These problems are compounded by fact that lower socio-economic group is associated not only with increased rates of mental illness 79 but also with younger age at presentation 10 and longer durations of untreated illness" -clinical features which are strongly associated with more severe forms of illness 18 and poorer outcomes.…”