The longer term outcomes of community care: a 12 year follow-up of the Camberwell High Contact Survey

Background. There is as yet little evidence available regarding the long-te rm outcomes of people with severe and enduring mental illness who have been cared for primarily in the community. Methods. A 12-year follow-up was carried out of the clinical and social pro blems and needs for care of a group of long-term mentally ill patients (N = 81) who were heavy users of psychiatric services when originally assessed in the Camberwell High Contact Survey between 1983 and 1985. The MRC Needs for Care Assessment Schedule used in the original baseline study was repeat ed at follow-up. Results. The clinical and social functioning of the group had remained rela tively stable, with high levels of problems and needs at both time points a nd little evidence of significant improvement or deterioration. The majorit y had remained in contact with services. There was some increase in levels of unmet as well as met needs, and a decrease in ratings of unmeetable need s, which may have been due to changes in clinical practice. Conclusion. The challenge for current service providers is not only to keep clients stable, but also to help improve the clinical and social functioni ng of people who may no longer be the highest priority of current community mental health services. This could be approached by identifying the contin uing needs of this group, and persistently delivering active treatments.