A Survey of Long-stay Schizophrenic Patients.

Cross, Harrington and Mayer-Gross (1957), in a survey of the long-stay population of a Birmingham mental hospital, came to the con clusion that “¿ onlyvery small proportions required constant vigilance and about two thirds required routine care only.. . . The large majority of patients were ambulant the whole day― but almost one-third had physical diseases of some kind. The major problem was the “¿ large number of passive, indolent and harmless chronic schizophrenics―. The authors specifi cally made the point that, “¿ to avoid chronicity and utilize every sign of improved behaviour and better adaptation which may lead to discharge, well-trained nursing staff and specialized knowledge is as much needed as in the treatment of earlier patients―. In a larger survey of all the patients in four Birmingham mental hospitals, Garratt, Lowe and McKeown (i@@7, 1958) found that 45 per cent. required no medical treatment and 64 per cent. needed no skilled nursing care. Forty-three per cent. needed limited super vision in the wards and a further 42 per cent. required no supervision if they did not leave the grounds; 14 per cent. required no super vision at all. The authors recommended that a substantialproportion of patients could be transferred to hostel type accommodation. More recently, Cooper and Early (196 i), surveying a Bristol mental hospital, found that 47 per cent. of patients were not in need of hospital facilities—most of them should be looked after in a “¿ longstayannexe or after care hostel―. However, they emphasized that “¿ supervised accommodation― of this kind solves no problem if the patient is merely transferred from one type of institution to another, and they recommended an approach in which rehabilita tion measures of all kinds—including specially set up industrial workshops—should be used to try to promote the resettlementof as many patients as possible. Resettlement is the per manent establishment of the patient in work so that he can be selfsupporting and live outside hospital. All these surveys have suffered from the dis advantage that the disabilities of the patients concerned were not directly measured, nor was any index of functionalhandicap used.To say that a patient needs no more than “¿ routine― supervision may mean that he is not unusually aggressive or destructive or it may reflect adversely on the present methods of nursing care. He may still suffer from various dis abilities which limit his chances of resettlement unless expert help is available. Although psychiatricdisabilities cannot yet be measured objectively according to under lying pathology, or abnormal physiology, it is possible to make a classification of certain fairly obvious difficulties which will at least show the dimensions of the problems involved. In the present survey measures of verbal symptomato logy, ward behaviour, industrial output, and certain attitudes were used to indicate the presence of various hindrances to discharge and resettlement in employment outside hospital.The study was limited to chronic schizophrenic patients under the age of 6o years, since this is by far the largest group of long-stay patients with considerable chances of resettlement. The hospital where the survey was carried out had a tradition of active treat ment for the past 20 years and a well-developed system of rehabilitationservicescovering the whole of the long-stay population. There had been a relatively high rate of discharge of long stay patients and the residual group was expected to present a range of very difficult problems. METHOD A register was made of all the 533 men and 1,266 women in Netherne Hospital on