From hospital to the community: The influence of deinstitutionalization on discharged long-stay psychiatric patients

The aim of the present study is to clarify the influence of deinstitutionalization on discharged long-stay patients based on a review of recently published literature. English-language studies were searched from PubMed and Embase for the years 2000-2012, with the terms long-stay' or chronic mentally ill' and deinstitutionalis(z)ation' or community' or discharged' in the title and/or abstract. The present study defined long-stay as hospitalization >6 months. A total of 14 articles were identified. The majority of the participants suffered from schizophrenia. The most frequently assessed outcomes were social functioning, psychiatric symptoms and quality of life (QOL)/participant attitudes towards the environment. For social functioning, most of the studies found favorable changes. As regards psychiatric symptoms, stability or at least some improvements were detected. For QOL/participant attitudes towards the environment, positive changes, at least at some time-points, were noted. Significant deterioration was rare in all of the three outcomes. The majority of the participants showed enhancements in social functioning despite the fact that functional impairment is common in persons with schizophrenia, which indicates that even long-stay patients could achieve better functioning by deinstitutionalization. Although the stability in symptoms might be due to continuous schizophrenia course, moving to the community may also lead to improvement. The favorable changes in QOL/participants' attitudes towards the environment are in line with other studies.