[Evaluation of the closure of large psychiatric hospitals in England]

In Britain, we are in the process of closing the majority of the old psychiatric hospitals. In 1954, there were 148,000 psychiatric beds, and in 1990 about 50,000 still remained. At Friern Hospital, in North London, a research team has studied 1,000 long-term in-patients who have been discharged from hospital. This paper sets out the results for the first 350 of these patients, discharged from Friern and Claybury hospitals between 1985 and 1990, comparing before and after discharge. In the first year after discharge 16% were readmitted to hospital. We used the following scales to measure the function of these patients: Present State Examination, Social Behaviour Schedule, Physical Health Index, Social Network Scale, Patient Attitude Questionnaire. One year after discharged, the majority of these measures showed no change. However, significant changes (p < 0.01) were noted for: the attitude of patients (who preferred their new way of life in the community), the costs of care (which were initially reduced by 5% for patients discharged from hospital), and for the improved quality of accommodation (which allowed more choice for patients). These first results suggest that care in the community is no worse, in many respects is better, and is no more expensive than hospital care.