Can we manage without the mental hospital?

Area of Science:

• Psychiatry
• Mental Health Services Research
• Health Policy

Background:

• Developed countries are shifting from large psychiatric hospitals to community-based mental health services.
• This transition raises questions about patient benefit and the effectiveness of deinstitutionalization.
• Evaluating the impact of this paradigm shift on patient outcomes is essential.

Purpose of the Study:

• To review evidence on the benefits of community-based psychiatric care versus traditional psychiatric hospitals.
• To assess the impact of deinstitutionalization on the quality of life for patients with and without dementia.
• To identify challenges and potential solutions in the transition to community mental health services.

Main Methods:

• Review of research, primarily from the Team for the Assessment of Psychiatric Services (TAPS) program in London.
• Inclusion of other relevant studies to provide a comprehensive overview.
• Analysis of patient quality of life, public attitudes, employment provisions, and care for dementia patients.

Main Results:

• Long-stay patients, including the elderly without dementia, report better quality of life in community homes.
• Relatives' opinions and observational studies indicate better care for dementia patients in community nursing homes.
• Public attitudes hinder social integration, but educational programs can help; employment provisions are lacking, though social firms show promise.

Conclusions:

• Community care offers advantages for long-stay patients, but significant challenges remain, particularly in admission facilities.
• Inadequate planning for admissions, lack of rehabilitation units, and insufficient sheltered accommodation require attention.
• Adequate investment in innovative facilities and targeted educational programs can resolve current issues and improve community-based mental healthcare.