The New Long Stay in an Inner City Service: a Tale of Two Cohorts

Abstract

We assessed the long-stay inpatients (length of stay >6 months) from a deprived inner-city catchment area with a population of 210000 in 1993 and 1995 on a variety of measures, following up both cohorts after 24 months. Total numbers of long-stay inpatients were reduced from 56 (26.7 per 100,000 total population) to 35 (16.7 per 100,000) between 1993 and 1995, in line with the closure of dedicated long-stay beds. The 1995 cohort were more symptomatic according to the BPRS (t= 2.8, P = 0.007, 95% confidence interval 18.1, 3.0), more commonly detained under the Mental Health Act (χ2 = 6.07 p = 0.05) and more commonly from an ethnic minority (χ2 = 3.7 p = 0.05). At 2 year follow-up 57% of the 1993 cohort were living out of hospital, compared with 60% of the 1995 cohort. Patients were discharged to a variety of settings, some highly supported. For the combined sample the presence of certain challenging behaviours (absconding, disturbance at night, non-compliance with treatment and violence) predicted continuing inpatient status as did three items on the Social Behaviour Schedule (bizarre behaviour, laughing to oneself and violence). Only five (9%) of the original sample remained inpatients for the entire four year follow-up.