THE OUTCOME OF TARGETING COMMUNITY MENTAL-HEALTH-SERVICES - EVIDENCE FROM THE WEST LAMBETH SCHIZOPHRENIA COHORT

Objectives-To report outcome of targeting community mental health serv ices to people with schizophrenia in an inner London district who had been shown; one year after discharge, to have high levels of psychotic symptomatology and social disability but very low levels of supported housing and structured day activity. Design-Repeat interview survey o f symptoms, disability, and receipt of care four years after index dis charge. Setting-Inner London health district with considerable social deprivation and a mental hospital in the process of closure. Subjects- 51 patients originally aged 20-65 years who satisfied the research dia gnostic criteria for schizophrenia. Main outcome measures-Contact with services during the three months before interview, levels of symptoms (from present state examination), global social disability rating. Re sults-65% (33/51) of the study group had been readmitted at least once in the three years between surveys. Recent contacts with community ps ychiatric nurses and rates of hospital admission increased (8 at one y ear v 24 at four years, p < 0.01; 5 v 13, p < 0.06). Conversely, fewer patients were in contact with social workers (17 v 7, p < 0.03). Prop ortions in supported housing, day care, or sheltered work did not chan ge. Unemployment rates remained very high. A considerable reduction (a lmost a halving) in psychiatric symptoms was observed, but there was n o significant change in mean levels of social disability. Conclusions- The policy of targeting the long term mentally ill resulted in signifi cant increases in professional psychiatric input to the cohort but fai led to improve access to social workers or suitable accommodation. Imp rovements in social functioning did not follow from reductions in the proportions of patients with psychotic mental states. Social intervent ions are likely to be crucial to achieving the Health of the Nation ta rget of improving social functioning for the seriously mentally ill, a s improving mental state seems in itself to be insufficient.