title: Care of patients with the most severe and persistent mental illness in an area without a psychiatric hospital.
abstract: OBJECTIVE
  With standard community resources, managing some patients with long-term mental illness can prove difficult, given the high level of care required. How many beds do such patients require? The study examined the prevalence, diagnostic and behavioral characteristics, and residential arrangements of a cohort of these patients in a semirural area of Canada (population of 291,500). The area has always functioned without a psychiatric hospital.
  
  
  METHODS
  A cross-sectional inquiry was made of all relevant institutions and residential facilities (including the local jail and shelters). Key stakeholders were interviewed and provincial databases were accessed in an effort to identify all adults aged 18 to 65 originating from the catchment area who displayed both a psychotic illness and severe behavioral disturbance necessitating ongoing close supervision. The Riverview Psychiatric Inventory was used to describe and quantify behavioral problems.
  
  
  RESULTS
  Thirty-six patients met the study criteria, for a prevalence of 12.4 per 100,000 in the general population. Most resided in a publicly funded nursing home or a well-staffed rural group home. Four (prevalence of 1.4 per 100,000) had a forensic profile, needed secure settings, and were long-term residents on acute care wards. Only one patient had transferred to a psychiatric hospital outside the catchment area.
  
  
  CONCLUSIONS
  Care for this population can be provided outside conventional psychiatric institutions but requires highly supervised long-term residential services in the range of ten to 40 per 100,000 in the population, depending on area characteristics, with urban, socially deprived areas likely having higher needs.
authors.affiliation: Department of Psychiatry, Faculté de Médecine, Universitéde Sherbrooke, IUGS-Argyll, 375 Argyll, Sherbrooke, Quebec, Canada J1J 3H5. jean-francois.trudel@usherbrooke.ca
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Trudel
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D016352:Group Homes / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing* / Q000523:psychology; D008875:Middle Aged; D020380:Needs Assessment; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D019035:Rural Health Services / Q000458:organization & administration*; D012720:Severity of Illness Index