Problems of transformation.

Despite the progressive reduction over many years in patient populations of psychiatric hospitals in America and many European countries, there have been few attempts to evaluate this policy. The Team for the Assessment of Psychiatric Services (TAPS) was established to monitor and evaluate the closure of two large psychiatric hospitals in North London. A number of important problems have been identified in the course of the TAPS research programme. These include: the inertia of the planning process, the selection of the best patients first for discharge at the expense of the more disabled, the accumulation of new long-stay patients entering the admission wards of psychiatric hospitals, the policy of introducing patients into the community as unobtrusively as possible, and the difficulties of deinstitutionalising staff. Despite these problems, evidence is presented that discharge of long-stay patients into the community has been relatively successful.