Background: Whereas the majority of long-stay in-patients have been successfully resettled in the community, there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes.
Aims: To study the long-term outcome of a group of 72 long-stay psychiatric inpatients, regarded as unsuitable for community placement.
Method: A prospective cohort study with follow-ups at 1 year and 5 years.
Results: The patients' mental state remained unchanged after 1 year and 5 years. The level of functioning and social behaviour showed minimal change after 1 year, but then improved over the next 4 years. The profile of problematic behaviours changed significantly over 5 years, with a reduction of 50% in their frequency. Physical aggression practically disappeared. The improvements in behaviour enabled 29 patients (40% of the study group) finally to be resettled in various care homes, gaining better access to community amenities and living more independently.
Conclusions: A high proportion of patients with severe disabilities, designated as 'difficult to place' in the community, could benefit from slow-stream rehabilitation within specialised facilities, enabling them to move into ordinary community homes.