Which patients first: a study from the closure of a large psychiatric hospital.

The decision to close down large psychiatric hospitals has led to many districts determining current patient dependency levels by conducting surveys of their hospital inpatient populations. This paper reports on the Claybury Hospital survey, which used Baker and Hall's REHAB scale to measure the level of patient functioning. The 641 patients assessed comprised the total long-stay and elderly, mentally-ill population of the hospital, excluding only patients on admission wards. Of these, 403 (63%) patients were in the 'severe handicap' category. In contrast, only 97 (15%) had 'potential for discharge'. A comparison of Claybury scores with those from other hospitals suggests that Claybury patients function at a lower level. Evidence is presented of 'creaming off' with respect to how one particular district has chosen patients, and this leaves behind an increasingly disabled hard core of patients. These findings are discussed and compared with other similar studies, and with respect to the Government's care in the Community policy.