title: Deinstitutionalization for long-term mental illness: a 6-year evaluation.
abstract: OBJECTIVE
  Forty-seven patients with long-term mental illness were transferred to the community following the closure of a psychiatric hospital in Sydney. This 6-year evaluation is an extension of a detailed clinical, ethnographic and economic study of the initial 2-years of community transition.
  
  
  METHODS
  Quantitative evaluation was conducted using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Assessments were completed prior to discharge and at two- and 6-year intervals following community transfer. Repeated measures analysis was utilized to determine changes in outcome variables over time. The residents' perception of 6-years of community living was explored in qualitative semistructured interviews. Details of accommodation, level of care, readmissions, incidents and medication were also documented.
  
  
  RESULTS
  During the 6 years following community relocation a total of seven residents returned to hospital for long-term care, three residents died from medical causes and one resident required detention in a corrective services facility. The 36 residents who remained in the community at the 6-year follow-up no longer required intensive 24-h supervision. Living semi-independently, 23 residents resided in two to three person accommodation with either daily or weekly case manager visits. Clinically, community residents remained stable over the 6 years without significant changes in psychiatric symptoms, depression, living skills or social behaviour problems. Clinical stability was achieved with significant reduction in medication levels over the 6 years. Community-based residents continued to experience improved quality of life and reported their marked preference for living in the community.
  
  
  CONCLUSIONS
  The residents maintained community tenure with significant improvement in quality of life and a reduction in medication, supported by a mental health system with adequate community resources. Issues regarding continuing rehabilitation and social integration need to be addressed. Further deinstitutionalization will require 24-h supervision for most initially and for some on a continuing basis. An ageing population will require specific age related medical and psychiatric services.
authors.affiliation: Department of Psychological Medicine, The University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia. chob9793@mail.usyd.edu.au
authors.forename: Coletta
authors.initials: C
authors.lastname: Hobbs
authors.forename: Lesley
authors.initials: L
authors.lastname: Newton
authors.forename: Christopher
authors.initials: C
authors.lastname: Tennant
authors.forename: Alan
authors.initials: A
authors.lastname: Rosen
authors.forename: Kate
authors.initials: K
authors.lastname: Tribe
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services; D003617:Dangerous Behavior; D003688:Deinstitutionalization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D012917:Social Adjustment