[The psychiatric hospital: from yesterday to tomorrow]

A study carried out in a psychiatric hospital in the Montreal region reveals that in spite of deinstitutionalization, long-term stay remains an important factor in the use of beds. For some patients the hospital remains a permanent home, either from their first admission or from the time they are institutionalized after multiple admissions. For both in- and out-patients, return to the hospital and long-term care are almost inevitable. Generally speaking, the services of the hospital are used by the same long-term patients, and this to the extent that the hospital cannot provide services to other establishments or play its second-line role. This is frustrating for other institutions in the network, even though they accept the inevitability of the situation given the lack of adequate community resources for these patients. One of the primary functions of a psychiatric hospital also seems to be to fill in the gaps in the service network. In this regard, its expertise in the field of intervention in chronic psychiatric patients must not be overlooked. Given the current situation, the hospital's responsibility in regard to second-line services cannot be clarified until it has been determined just how much of the responsibility for care of psychiatric patients can be assumed by the community itself.