title: The impact of realigning a tertiary psychiatric hospital in British Columbia on other institutional sectors.
abstract: OBJECTIVE
  Deinstitutionalization is an ongoing process, as many jurisdictions continue to struggle with redesigning their psychiatric systems. Historically, reducing psychiatric beds and closing hospitals have resulted in deleterious outcomes for people with severe and persistent mental illness. More recent evidence suggests that careful implementation of deinstitutionalization policies can thwart potential adverse consequences and may even foster favorable outcomes. This study evaluated the extent to which the recent devolution of the only tertiary psychiatric hospital in British Columbia resulted in a direct shift of individuals to other institutional sectors, such as criminal justice and health sectors.
  
  
  METHODS
  Admission rates to general hospitals, continuing care facilities, correctional institutions, and forensic psychiatric facilities were compared among two patient groups: those discharged before the realignment of the tertiary psychiatric hospital system (prerealignment cohort) (N=164) and those discharged after initiation of the system reforms (postrealignment cohort) (N=171).
  
  
  RESULTS
  Most of the patients in the postrealignment cohort have remained in the tertiary care settings to which they were originally discharged. For patients in the postrealignment cohort, contact with other institutional sectors was rare and shorter in duration than it was for patients in the prerealignment cohort.
  
  
  CONCLUSIONS
  This study provides preliminary evidence that recent efforts to realign British Columbia's provincial tertiary psychiatric hospital system have not resulted in a significant shift of the relocated patients to institutions in other sectors.
authors.affiliation: Forensic Psychiatric Services Commission, 70 Colony Farm Rd., Port Coquitlam, British Columbia V3C 5X9, Canada. jlivingston@forensic.bc.ca
authors.forename: James D
authors.initials: JD
authors.lastname: Livingston
authors.forename: Tonia
authors.initials: T
authors.lastname: Nicholls
authors.forename: Johann
authors.initials: J
authors.lastname: Brink
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001955:British Columbia / Q000453:epidemiology; D003416:Criminal Law / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D055815:Young Adult