Patients who are difficult to place - A description of the patient characteristics, admission patterns, and need for care

A distinct group-the difficult-to-place patients-has appeared in connection with the reorganization process in psychiatry. There is no exact definitio n of this group, and only a few studies describe the patients in detail. Th e present study describes the characteristics, admission patterns, and need for care of a group of difficult-to-place patients in Roskilde County, Den mark. The patients were a sociodemographically marginalized group. Most of them were schizophrenics, and two-thirds had a dual diagnosis of alcohol or drug abuse. These patients functioned poorly and had a great need for care and help. As assessed with the CAN, the staff found a greater need for car e compared with the patients' assessments with regard to the psychiatric di sease, substance abuse, self-care, and problem behaviours. It is our hypoth esis that it is the great number of needs in various domains-that is, the s evere disabilities in addition to the patients' lack of insight into their need for care, problem behaviour, and alcohol and illicit drug abuse-that m ake these patients difficult to place in the community. But to be difficult to place in the community is not only something embedded in the patient al one. If relevant services were established, the term "difficult to place" m ight be changed to "severely disabled" psychiatric patients.