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PubMed1993

The TAPS Project. 12: Crime, vagrancy, death and readmission of the long-term mentally ill during their first year of local reprovision.

The extent of crime, vagrancy, death, and readmission in a prospective cohort of long-term mentally ill patients was measured during their first year out of hospital. All 278 long-stay psychiatric patients discharged during the first three years (1985-1988) of the closure of Friern and Claybury Hospitals were included. One patient was imprisoned, one committed suicide, and one became vagrant; five others may also have become vagrant. The mortality rate was similar for the leavers and their matched controls, who remained in hospital. There was one suicide among the matches. Mental deterioration most often caused readmission. On recovery, most patients returned to their community home. Six per cent of the cohort were readmitted and have remained in hospital for a year or more. With careful planning and a financial 'dowry' for each patient, the closure of large mental hospitals does not lead to a marked increase in vagrancy, crime, and mortality for the long-term mentally ill. However, the patients who have yet to leave have more problems of social behaviour and are likely to be more difficult to resettle.

Adult↗
PubMed1996

Factors affecting the success of community placement: the TAPS project 26.

Long-stay patients who were discharged from Friern and Claybury hospitals during the 6-year period between September 1985 and August 1991 were followed up for at least 1 year and the details of all readmissions were recorded. Of the 615 hospital leavers, some 178 (29%) were readmitted at some time during the follow-up period. A proportional hazards regression analysis revealed a number of independent baseline factors which affect the risk of readmission at any time during the follow-up period. Younger patients were more at risk of readmission than were older patients and 'new' long-stay patients had a greater risk than baseline patients. Risk was also greater in patients who had a larger number of pre-discharge admissions, a higher abnormal behaviour score (PSE BSO) or a diagnosis of manic psychosis. An ordinal logistic regression analysis revealed that these same five factors tended to increase the actual number of readmission episodes. The proportion of post-discharge time spent in hospital among the readmitted patients was found to be greater for males, new long-stay patients and for patients with a higher number of positive social behaviour symptoms (SBSPOS score).

Activities of Daily Living↗
PubMed1990

The TAPS Project. 5: The structure of social-network data obtained from long-stay patients.

The Social Network Schedule was successfully completed on 489 (64%) of 770 long-stay patients in Friern and Claybury Hospitals and the data on 3774 social contacts of the patients subjected to log-linear modelling. This showed that the category 'confidant' was salient in understanding the data. Latent-class analysis highlighted the importance of the nature of the social interaction between patients and their contacts. In particular, non-verbal exchanges of goods and services emerged as important in creating social bonds.

Arousal↗
PubMed1992

The TAPS project. 6: New long-stay psychiatric patients and social deprivation.

The clinical and social characteristics of new long-stay (NLS) patients at Friern and Claybury hospitals are described, together with their accumulation rates within health districts in northeast London, and the associations between accumulation rates and social deprivation. There is a fourfold variation between local districts in annual accumulation rates of NLS patients (between 2.5 and 11 per 100,000 population); 0.55 of this variation is accounted for by the Jarman scores of social deprivation, and 0.81 by local rates of unemployment. Other recent British studies support this finding that measures of social deprivation can statistically explain a large proportion of the variation in treated rates of psychiatric morbidity, and may be useful in predicting needs for psychiatric services.

Adult↗
PubMed1994

The TAPS Project. 22: A five-year follow-up of long-stay psychiatric patients discharged to the community.

A group of 114 long-stay patients in Friern and Claybury Hospitals was assessed while in hospital, and then again one year and five years after discharge to community placements. Neurotic symptoms, verbal and non-verbal behaviour and, most notably, negative symptoms all improved between the two community follow-up interviews. Patients were living under much less restrictive conditions in the community, and their appreciation of this freedom continued to grow over the years. Their social networks were enriched by an increase in the number of friends in the first year after discharge and in the number of confidants in the subsequent four years. There were no adverse outcomes, but these conclusions cannot yet be said to apply to all long-stay residents of mental hospitals.

Activities of Daily Living↗
PubMed1992

The TAPS project. 16: Difficult to place, long term psychiatric patients: risk factors for failure to resettle long stay patients in community facilities.

OBJECTIVE: To identify patients who could not be resettled in the community as part of the closure plans of two psychiatric hospitals and to determine their numbers and risk factors for failure. DESIGN AND SETTING: Prospective study of the closure of Friern and Claybury psychiatric hospitals. PATIENTS: The first third (369) of long stay psychiatric patients to be resettled. OUTCOME MEASURES: Reasons for patients being readmitted to hospital and not leaving the patients' service needs. RESULTS: 22--6% of both hospitals' long stay patients--were not successfully resettled in the community. Eighteen continuing care places per 100,000 of catchment area population seem to be required for this group. Patients whose placements were unsuccessful were usually readmitted because of a deterioration of their mental state and aggressive behaviour, both of which persisted and necessitated their continuing stay in hospital, often in a locked ward. Risk factors associated with failure were a high level of psychosis; a diagnosis of paranoid psychosis; incontinence; and being male. But having a social network, especially a large one, seemed to aid successful placement in the community. CONCLUSION: Rehabilitation efforts should be focused on the characteristics of these patients that put them at risk of failing to succeed in community placements.

Community Mental Health Services↗