[The chronic schizophrenic: inpatient or outpatient?]

The English School of Social Psychiatry has insisted upon the importance of social factors over the incidence, course and prognosis of mental illness. To confirm some of these findings, a special Project was undertaken within all the psychiatric patients corresponding to a population of about 280,000 inhabitants living in a sectorized area with full in- and out- patients facilities contained in a Swiss urban area. A first study found that only 15% of all the psychiatric patients had been in hospital for more than a continuous year (0.14% of the sector). A variety of psychopathological, social and diagnostic variables were assessed. It was confirmed that services within the community can reduce significantly the number of chronic in-patients, making an admission of more than one year rarely necessary for most patients. The reasons for a long admission appear to be social rather than psychopathological and/or diagnostic. Among the patients, a good rehabilitation prognosis could be predicted for at least half of the population. A second trial studied all patients within the socio-professional rehabilitation services (N=81). The best predictors for a one-year positive assessment of success were found to be: good social relations within a work context, positive work expectations from the subject himself his family and his therapeutic team, married status, initial depressive symptoms, less than 5 years of work cessation and phenothiazine medication. The need for a coherent net of psychiatric services is emphasized, especially so, when "new" long-stay patients appear to be replacing the "old" chronic asylum inmates in most urbanized areas.