Donnelly M, McGilloway S, Mays N, Perry S, Lavery C
Health and Health Care Research Unit, Queen's University of Belfast, Northern Ireland.
Soc Psychiatry Psychiatr Epidemiol. 1997 Nov;32(8):451-8. doi: 10.1007/BF00789139.
Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.
对于在北爱尔兰医院出院政策正式实施之前及实施期间就已出院的首批患者，人们了解甚少。本研究描述了1987年至1990年间从北爱尔兰六家主要精神病医院出院的 former long-stay患者（其中约三分之二的ICD-9诊断为精神分裂症）的居住安置模式（n = 321）。该研究还在一项回顾性调查设计中采用了多种工具，以检验1990年至1997年间出院并于1993年接受随访的35%的患者（112/321）的结局。近三分之二（61%）的患者出院后入住独立生活场所或人员配备较少的法定机构。在出院后的头两年里，该组患者中无人无家可归，1人入狱，3人自杀。在6年期间，近三分之一的患者在某个阶段不得不再次入院，13%的患者已经死亡。报告显示，不到25%的患者在大多数日常生活技能方面存在“中度”至“严重问题”，而存在问题行为的患者比例为15%或更低。约90%或更多的患者对新家的大多数方面感到满意，大多数患者还表示自出院以来感觉更快乐（77%）、更健康（63%）和更独立（78%）。然而，社会、娱乐和职业机会有限。购买者、提供者和从业者需要审视如何增强 former long-stay患者的能力，使其在社区中过上更有意义、更融入社会的生活，特别是鉴于北爱尔兰当前的健康和社会福祉政府战略（1997 - 2002年）指出要关闭现有的精神病医院。
