BACKGROUND: The clinical and social outcomes were evaluated of "difficult to place" (DTP) patients discharged from hospital to alternative facilities. METHOD: In the course of a reprovision programme for a psychiatric hospital, 72 long-stay patients were considered to be too problematic to live within the usual range of community placements. Their clinical and social state was assessed shortly before the hospital closed. Severe, persistent behavioural problems were recorded for each subject at baseline. One year after being relocated, patients were reassessed. RESULTS: Clinical and social measures were stable over time. The profile of severe behavioural problems changed over time, with one-third of the total problems subsiding and a similar number of new problems emerging. There was a significant reduction in physical aggression. One of the settings provided an environment as free of restrictions as the usual community homes. CONCLUSIONS: The most difficult patients to reprovide for can be contained in a relatively non-restrictive care environment. There is some indication that aggressive behaviour can improve, raising the possibility that some DTP patients can move on to the usual community homes.
BACKGROUND: The clinical and social outcomes were evaluated of "difficult to place" (DTP) patients discharged from hospital to alternative facilities. METHOD: In the course of a reprovision programme for a psychiatric hospital, 72 long-stay patients were considered to be too problematic to live within the usual range of community placements. Their clinical and social state was assessed shortly before the hospital closed. Severe, persistent behavioural problems were recorded for each subject at baseline. One year after being relocated, patients were reassessed. RESULTS: Clinical and social measures were stable over time. The profile of severe behavioural problems changed over time, with one-third of the total problems subsiding and a similar number of new problems emerging. There was a significant reduction in physical aggression. One of the settings provided an environment as free of restrictions as the usual community homes. CONCLUSIONS: The most difficult patients to reprovide for can be contained in a relatively non-restrictive care environment. There is some indication that aggressive behaviour can improve, raising the possibility that some DTP patients can move on to the usual community homes.