The Scottish survey of old long-stay in-patients

The physical health of old long stay in-patients in one psychiatric hospital

The provision of care for patients with chronic mental illness is changing with the gradual closure of mental hospitals and the expectation that this group will be largely cared for in the community. In Scotland the process is only beginning. A recent Scottish survey examined the demographic, social and clinical characteristics of 2605 “old long-stay” in-patients, defined as those in hospital more than six years and under 65 years of age at the time of last admission (McCreadie et al, 1991). Patients in 18 psychiatric hospitals serving 83% of the Scottish population were studied. Results showed the population was elderly, 70% being over 60 years of age, and nearly 40% over 70 years. The aim of the present study was to look at the physical health of the old long-stay population in one hospital, namely Crichton Royal, Dumfries, because of the implications of physical health care needs for the management of this group in the community.

QUALYOP Project 2: monitoring the dismantling of Italian psychiatric hospitals. Psychotropic drug use in 1072 inpatients

OBJECTIVE

This study describes the use of psychotropic drugs in a sample of eight Italian psychiatric hospitals.

METHODS

A cross-sectional approach was used to collect information about sociodemographic and clinical characteristics of the inpatient population, and about medications prescribed. Prescribing behaviour in the hospitals was compared using three indicators: the number of patients taking psychotropic drugs, the use of high doses of neuroleptics and the use of multiple neuroleptics.

RESULTS

More than a thousand patients were resident in the eight hospitals on the census day, 56% of them males. Half the population had an ICD-X diagnosis of schizophrenia, one third of mental retardation. Sixty-nine percent of the sample was on neuroleptic therapy, nearly 47% on benzodiazepines and 4% on antidepressants. Twenty percent of the sample did not take any psychotropic drug on the census day. After adjustment for sociodemographic and clinical variables, setting-related variables resulted as determinants of psychotropic drug use.

CONCLUSIONS

These data call for continuing education in psychopharmacology towards a more rational use of drugs; longitudinal audits of clinical practice should be implemented to guide clinicians toward a more rational use of psychotropic drugs.

The Qualyop Project. 1: Monitoring the dismantlement of Italian public psychiatric hospitals. Characteristics of patients scheduled for discharge

OBJECTIVES

Monitoring and evaluating the Italian psychiatric hospitals closure process, stated by the law to be concluded by 31 December 1996, and then postponed to 31 March 1998, identifying characteristics related to the possibility of discharge in 4493 patients living in twenty-two public psychiatric hospitals.

METHOD

Sociodemographic and clinical data, information on impairment and functioning and plans for discharge in the subsequent twelve months of all patients were collected at baseline using a standard questionnaire.

RESULTS

Discharge was planned within twelve months for 11% of the patients: 4% to other psychiatric or non-psychiatric institutions and 7% to community settings. Severely disabled patients and patients with some behavioural problems were more frequently scheduled to go to institutional settings. For both types of discharge, an adequate network of social relationships was an important determinant. Patients were more frequently planned for discharge if they resided in hospitals with a higher care providers/patients ratio, and in Emilia Romagna and Rome, than in Lombardy and Liguria.

CONCLUSION

Frequency of planned discharge depended partly on the patients' personal characteristics related to independence and functioning, but the effect of these factors on frequency of planned discharge was influenced by characteristics of the hospitals where the patients lived.

Closure of an asylum: the Friern study of older people

This article reports a naturalistic study following the closure of Friern Hospital and the movement of elderly long-stay patients, who in the main suffered from severe dementia, to psychiatric nursing homes and hospital beds. It describes changes in the environments and in the patients' cognition, behaviour and use of medical services. The results suggest that psychiatric nursing homes seem able to care for the majority if patients with severe dementia. Future studies should consider whether long-stay hospital beds may, however, be necessary for those with both psychiatric and physical health needs, where increased contact with health service personnel is essential. Prospective examination of the reasons for breakdown of placements in nursing homes and the differences between those placed in various settings may help future planning of services. Relatives' opinions of the long-stay settings also require study.

Psychiatric disorder and disability in New Zealand long-stay psychiatric patients

A study was undertaken of the prevalence of physical disease, psychiatric disorder and deviant behaviour in a sample of 137 long stay psychiatric patients at Porirua Hospital near Wellington, New Zealand. Patients were in the main male, single, middle-aged to elderly and of European descent. Schizophrenia was the most common diagnosis. Psychiatric symptoms were moderately severe, the most common being unusual mannerisms and posturing, anxiety, blunted affect, tension, unusual thought content and somatic concerns. Known physical disorders were present in 66 patients. Levels of neuroleptic medication were high and tardive dyskinesia was observed in almost 60% of patients. Frequency of deviant behaviour was low in absolute terms but nonetheless problematic. The frequency of deviant behaviour was similar to those reported for British patients.

Long term secure care in Tasmania

The aim was to determine the requirement in Tasmania for long term (greater than 28 days) secure ward beds, and to characterise the patients who use them. There was complete enumeration over an 18 month period. The results included that 3.6 long term secure beds were used per 100,000 general population. Compared to those who were discharged during the survey, those who were not discharged were older, had spent longer in psychiatric hospitals and were more likely to be male and to suffer from schizophrenia. All patients were white Australians. The conclusions included that for planning purposes a minimum of 4.6 long term secure beds was required per 100,000 general population. Also, Aboriginal people and people from non-English speaking backgrounds were not over represented in long term secure care in Tasmania. Finally, "good" and "poor" prognosis groups were identified and further work is required to determine how these can best be managed.