I. Downsizing psychiatric hospitals: Needs for care and services of current and discharged long-stay inpatients

Background: With the psychiatric deinstitutionalization movement in its fou rth decade, questions are being raised concerning its relevance for long-st ay inpatients with severe disabilities and the risk that those discharged i nto the community may be abandoned. Methods: A random sample taken in 1989 of long-stay inpatients at Louis-H L afontaine Hospital made it possible to examine 96 pairs of patients. Each p air included 1 patient discharged between 1989 and 1998 and 1 patient hospi talized. Pairs were matched for sex, age, length of stay, and level of psyc hiatric care in 1989. Patients and staff were interviewed using standardize d questionnaires, and case notes were reviewed to assess symptoms, daily li ving skills, residential status, quality of residential setting, and clinic al and social problems and needs. Results: The investigation revealed that discharged patients moved to highl y supervised settings, which included professionally supervised group homes , supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patien ts were lost to follow-up, of whom 2 were probable vagrants. Both those dis charged and those remaining as inpatients presented with major clinical pro blems and daily living skill deficits. The care needs of discharged patient s were generally met. and placement in the community was considered appropr iate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% requir ed intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing be haviours. Conclusion: Deinstitutionalization in the largest Canadian psychiatric hosp ital did not lead to patient abandonment in the community.