Planning for community care: long-stay populations of hospitals scheduled for rundown or closure

Article Abstract:

There is an ongoing trend toward deinstitutionalization of psychiatrically hospitalized patients in the UK. The prospect of deinstitutionalization has raised the question of whether these patients can be adequately cared for in the community, and how. The population is characterized by high levels of disability, which requires large amounts of staff support. Surveys of five psychiatric hospitals that were involved in planning for the community care of their patients were reviewed in an effort to determine the characteristics of the patient populations and whether or not there was a need for inpatient facilities to care for them. The total sample of patients covered by the surveys was 1,308. Staff completed the Community Placement Questionnaire for all patients, which provided information regarding demographics, social functioning, behavior, disability, and needs in the community. Average age of the population was 64.5 years, with an average length of stay of 24.5 years. Seventy percent were diagnosed as schizophrenic, 12 percent were depressed, three percent were mentally retarded, and seven percent had organic syndromes such as epilepsy. More than half needed assistance with activities of daily living, 32 percent had physical disability, and about 10 percent were rated as being a danger to themselves or others. Sex and length of stay did not affect the statistics. A subpopulation was identified as the new long-stay population, including those with an average age of 45 years who were admitted recently, accounting for 23 percent of the sample. The results of the review show that in the UK psychiatric hospitals contain a mostly elderly and disabled population, suggesting that the hospitals are discharging more able patients to the community, but there are significant numbers of more able patients still hospitalized, suggesting the need for more community facilities. Due to the levels of disability of patients currently hospitalized, deinstitutionalization will require highly staffed community care as well. This is not currently available in the UK, which means that high numbers of these patients will likely accumulate in hospitals or prisons. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Long-term care of the sick, Long term care, Deinstitutionalization

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Day care in an inner city: I. Characteristics of attenders

Article Abstract:

Community-oriented psychiatric services include day-care programs, though the design and scope of such programs remain a subject of debate. Data on attenders of psychiatric day-care centers in an inner city were surveyed and compared with data on attenders at psychiatric day hospitals. Day-care attendees were divided into two groups: those who had been in continuous contact with some type of psychiatric service for at least a year, and those who had been in contact for less than a year. Of the 115 subjects in the former group, 110 agreed to be studied further and they are the focus of this report. They filled out a Social Performance Interview and day-care staff completed a Social Performance Questionnaire for each subject. Social skills scores were calculated from these data, and socioeconomic data were collected as well. Numbers of men and women in the sample were about even. Mean age was 46 years old, 24 percent of the subjects were ethnic minorities, and half were single. Impairment was found in shopping skills (24 percent), cooking (25 percent), household chores (32 percent), and managing money (21 percent). Social skills impairment was present in 30 percent of the sample as well. Slightly less than half of the sample was diagnosed as schizophrenic or otherwise psychotic, and most had long psychiatric histories. All but 10 had a history of inpatient psychiatric treatment. Thirty-eight percent were clinically depressed, and 34 percent exhibited other neurotic symptoms such as anxiety. Overall, the attendees at these day clinics were markedly similar to those attending national day hospitals and therefore the needs for treatment and care of attendees at both types of facilities may be similar. The distinction between day hospitals, traditionally seen as medical institutions, and day-care centers, seen as social institutions, may not be appropriate. This has implications for policy setting and staff training. (Consumer Summary produced by Reliance Medical Information, Inc.)

Community psychiatric services, Community mental health services, Hospital day care

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The classification of psychiatric morbidity in attenders at a dermatology clinic

Article Abstract:

One hundred seventy-three adults randomly selected from all new patients at a dermatology outpatient clinic were studied to assess relationships between skin disorders and psychiatric morbidity. The average age of the patients was 42 years. They were given a battery of tests to measure general health, psychiatric symptoms, anxiety, depression and attitudes to appearance. They also took a test to measure the impact of skin disease on behavior. Behavioral measures included time spent on appearance, cosmetic use, self-scrutiny, avoidance of others, embarrassment and sexual problems. Dermatologists rated skin diagnoses and the extent and location of visible skin disease. Data analysis revealed no significant relationships between psychiatric morbidity, diagnoses, or extent of skin disease. However, whether the illness was chronic, and the visibility of exposed diseased areas both had an effect on behavioral impact scores. Attitudes to appearance were found to be more closely related to psychiatric morbidity than any of the physiological aspects of skin disorders. Forty percent of all study subjects were diagnosed with a psychiatric disorder. The majority of disturbances were mood disorders. Among patients who reported little behavioral impact, 20 percent were diagnosed with psychiatric disturbances, compared with 59.5 percent of the patients who reported high impact. Females had significantly higher impact scores and higher scores on perfectionist attitudes than males. Results do not support arguments that psychiatric disorders lead to the development of skin disease, but, instead, point to the importance of attitude and behavior in the development of psychopathology. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Skin diseases, Body image

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