title: Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community. TAPS Project 44.
abstract: BACKGROUND
  Whereas the majority of long-stay in-patients have been successfully resettled in the community, there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes.
  
  
  OBJECTIVE
  To study the long-term outcome of a group of 72 long-stay psychiatric inpatients, regarded as unsuitable for community placement.
  
  
  METHODS
  A prospective cohort study with follow-ups at 1 year and 5 years.
  
  
  RESULTS
  The patients' mental state remained unchanged after 1 year and 5 years. The level of functioning and social behaviour showed minimal change after 1 year, but then improved over the next 4 years. The profile of problematic behaviours changed significantly over 5 years, with a reduction of 50% in their frequency. Physical aggression practically disappeared. The improvements in behaviour enabled 29 patients (40% of the study group) finally to be resettled in various care homes, gaining better access to community amenities and living more independently.
  
  
  CONCLUSIONS
  A high proportion of patients with severe disabilities, designated as 'difficult to place' in the community, could benefit from slow-stream rehabilitation within specialised facilities, enabling them to move into ordinary community homes.
authors.affiliation: Chase Farm Hospital, Enfield, UK.
authors.forename: Noam
authors.initials: N
authors.lastname: Trieman
authors.forename: Julian
authors.initials: J
authors.lastname: Leff
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D003688:Deinstitutionalization; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008131:London; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012919:Social Behavior