Institutional dependence is reversible

A project is described whereby in 12 months, 105 long-stay psychiatric patients were able to be discharged to the homes of private individuals to become members of a 'family', to whom they were not related. The task necessitated a change in attitudes of the whole hospital staff--as resistance to change was encountered in staff at all levels. A consultant psychiatrist and a social worker interviewed all the long-stay patients in the wards and with the charge nurse decided whether they could live outside the hospital given an appropriate environment. In achieving success it was calculated that the time spent on interviews, assessing placements, discussing after-care and being available to answer the many enquiries from all concerned, amounted to 1 1/2 weeks work for each patient. However, this must be considered in relation to the hours spent by professional and other hospital staff over the years spent as an inpatient.