Recovering the Capacity to Live outside of a Psychiatric Hospital: Impact of a Specialized Inpatient Program
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Recovering the Capacity to Live outside of a Psychiatric Hospital: Impact of a Specialized Inpatient Program Pierre Lequin 1 & Philippe Golay 1,2 & Fabrice Herrera 1 & Marie-Anne Brisard 1 & Philippe Conus 1 Accepted: 17 September 2020/ # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Deinstitutionalization in psychiatry led to a decrease in hospital beds, short hospital admissions focussed on symptoms reduction, and the development of ambulatory care. However, the needs of patients who despite symptoms reduction do not display the minimal competencies to live alone or in a sheltered accommodation, are not met in such a context. They usually go through long admissions and fail to improve. In 2016, we implemented a new inpatient program focused on fostering the development of the competencies needed to adapt to living outside the hospital; the aim of this study was to evaluate if it lead to the resolution of these situations or in contrary if it turned into a long stay unit. 116 patients admitted to the program between 2016 and 2018 were included in the study. They were psychiatric inpatients who had no home, did not find a place in a sheltered accommodation and couldn’t be discharged. In the majority of cases, the situation was resolved within 180 days and the majority of patients was referred to a sheltered accommodation. Functional and symptom levels improved significantly over time. A specific focus on restoring competencies to live outside of hospital allows complex patients to improve their functional level and to find a place to live in the community within a relatively short time. While deinstitutionalization has been beneficial to the vast majority of patients, denying the specific needs of a minority of patients leads to unnecessary long and inefficient hospital admissions. Keywords Deinstitutionalization . Housing . Severe mental illness . Social difficulties
* Pierre Lequin [email protected]
1
Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Route de Cery, 1008 Prilly, Lausanne, Switzerland
2
Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
Psychiatric Quarterly
Introduction Deinstitutionalization of mental health services, which in our region occurred mainly between the seventies and the eighties and continued through the nineties, changed psychiatric treatments radically. It led to a drastic decrease in hospital beds and to the progressive development of ambulatory care and support in the community. In addition, a substantial proportion of the hospital beds was replaced by sheltered accommodations specialized in long-term care for psychiatric patients. Although the overall good quality of such facilities is not in question, their positive impact on psychosocial outcome is not clearly demonstrated yet [1]. In addition, they often became narrowly specialized over time on specific patients profile, mainly on those wit
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