Long-term patients in supported housing after deinstitutionalisation - Part V of the Berlin deinstitutionalisation study

Objective: In part IV of the Berlin Deinstitutionalisation Study, we report ed a positive change in quality of life for 65 resettled patients one year after discharge. In this part, we investigated changes in a longer follow-u p period. Methods: A group of 66 patients discharged into supported housing was assessed one and five years after baseline. Quality of life, needs for care, patients' assessment of treatment, re-hospitalisation and characteri stics of care were studied in a control-group design. Results: After five y ears, 61 % of the patients continued to live in highly staffed settings (me an staff-patient-ratio: 1 :3.5). Eleven percent had moved on to independent living and 16 % had returned into an institutional setting. Standard morta lity ratios were 4.4 (all causes of death) and 62.5 (2 suicides only of sch izophrenic patients). After one year patients (n = 20) showed a significant increase in satisfaction with their living situation and more social conta cts. Over the longer period of time, there were also favourable changes, wh ich failed to reach statistical significance (n = 24). Average length of in patient stay per year of the illness was decreased significantly at both fo llow-ups. Conclusions: Interpretation of the findings is difficult because of the small sample size and selection effects. Most of the former long-sta y patients appear able to live in the community with a significant decrease of time spent in hospital. Whilst patients were particularly satisfied wit h their accommodation at one year follow-up, this did not lead to a general ised improvement in subjective quality of life and other subjective criteri a in the long term. In line with other recent studies on community mental h ealth care one may conclude that small case loads alone do not have major b eneficial effects. Further research should evaluate more systematic and tar geted models of mental health care in the community in general and of suppo rted housing in particular.