Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland.
OBJECTIVE
We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland.


METHODS
Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile.


RESULTS
In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved.


CONCLUSIONS
In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.
Honkonen
Teija
T
Section of Clinical Neurosciences, Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, FIN-00250 Helsinki, Finland. teija.honkonen@occuphealth.fi
Karlsson
Hasse
H
Koivisto
Anna-Maija
AM
Stengård
Eija
E
Salokangas
Raimo K R
RK
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003688:Deinstitutionalization / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011584:Psychology; D012559:Schizophrenia / Q000453:epidemiology* / Q000628:therapy*