The outcome of targeting community mental health services: evidence from the West Lambeth schizophrenia cohort.
OBJECTIVE
To report outcome of targeting community mental health services to people with schizophrenia in an inner London district who had been shown, one year after discharge, to have high levels of psychotic symptomatology and social disability but very low levels of supported housing and structured day activity.


METHODS
Repeat interview survey of symptoms, disability, and receipt of care four years after index discharge.


METHODS
Inner London health district with considerable social deprivation and a mental hospital in the process of closure.


METHODS
51 patients originally aged 20-65 years who satisfied the research diagnostic criteria for schizophrenia.


METHODS
Contact with services during the three months before interview, levels of symptoms (from present state examination), global social disability rating.


RESULTS
65% (33/51) of the study group had been readmitted at least once in the three years between surveys. Recent contacts with community psychiatric nurses and rates of hospital admission increased (8 at one year v 24 at four years, p < 0.01; 5 v 13, p < 0.06). Conversely, fewer patients were in contact with social workers (17 v 7, p < 0.03). Proportions in supported housing, day care, or sheltered work did not change. Unemployment rates remained very high. A considerable reduction (almost a halving) in psychiatric symptoms was observed, but there was no significant change in mean levels of social disability.


CONCLUSIONS
The policy of targeting the long term mentally ill resulted in significant increases in professional psychiatric input to the cohort but failed to improve access to social workers or suitable accommodation. Improvements in social functioning did not follow from reductions in the proportions of patients with psychotic mental states. Social interventions are likely to be crucial to achieving the Health of the Nation target of improving social functioning for the seriously mentally ill, as improving mental state seems in itself to be insufficient.
Conway
A S
AS
United Medical School, Guy's and St Thomas's Hospital, London.
Melzer
D
D
Hale
A S
AS
D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D006801:Humans; D008607:Intellectual Disability; D008131:London; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012111:Residence Characteristics; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012946:Social Welfare; D014504:Urban Health