Chronic mental illness : a study of clinical and social factors related to the outcome of patients discharged from mental hospitals

A hollow -up study was made of 240 mala patients discharged from seven metropolitan mental hospitals after a stay of more than two years. Information was sought about the patients' outcome in terms of readmission to hospital and in terms of his behaviour and work record during the twelve months following discharge. A. schedule of inquiry covering 160 items of information was completed for 229 (95 per cent) of the patients. A The patients' outcome was assessed in terms of two criteria: (l) survival in the community for at least one year, and for those who so survived: (2) a rating of their level of social adjustment. Sixty -eight per cent of the patients remained out of hospital for at least one year, two- thirds of these attaining full or partial social adjustment.Among factors associated with outcome, the patients' degree of freedom from the grosser signs of mental illness was of first importance. Having allowed for this, two social factors were found to be significantly related to outcome: (1) If a patient succeeded in finding employment, he was less likely to relapse; (2) Significant differences in relapse rates were found for schizophrenic and non -schizophrenic patients respectively in different types of household. Schizophrenics farad worst when they went to live with their parents or wives; non-schizophrenics fared wor3t when doing to lodgings or to other relatives. The findings suggest that schizophrenics benefit from surroundings in which they are not exposed. to intimate personal relationships but are expected to fend for themselves. In this respect they differ from patients suffering from other types of chronic disability.The follow -up study revealed that a minority of these patients were surviving in the community at the expense of causing inconvenience, and in some cases suffering, to other 4 persons in their households. This is a consideration which has to be borne in mind when considering contemporary proposals for increasing "community care" for mental illness: the evaluation of such programmes requires that a measure of their cost to the community in terms of hardship should be weighed against their advantages for the individual patients.PUBLISHED ARTICLE: Post -Hospital Adjustment of Chronic Mental Patients. By G. W. BROWN, G. M. CARSTAIRS, GILLIAN TOPPIN