The TAPS Project. 10: The long-stay populations of Friern and Claybury hospitals. The baseline survey.

As part of the TAPS project, the baseline long-stay populations of Friern and Claybury Hospitals were compared using the TAPS assessment schedules. Each hospital has reduced bed numbers by two-thirds, and although the two have been subjected to different influences, their remaining long-stay patients were similar, and characterised by severe problems with hygiene, florid psychotic symptoms, a high prevalence of negative symptoms, and impoverished social networks.

The TAPS Project. 13: Clinical and social outcomes of long-stay psychiatric patients after one year in the community.

The first prospective, controlled study of a large, long-stay, in-patient population as their hospital services were reprovided in the community is reported. Two-hundred-and-seventy-eight patients were matched individually with similar patients who remained in hospital. Clinical and social outcomes over a one-year follow-up are presented for the first three years of the reprovision process. Compared with matches, the leavers at follow-up had more diverse social networks that contained a higher proportion of contacts named as friends. The care facilities in the community allowed more opportunities for patient autonomy than the hospitals across all aspects of the environments measured. At follow-up, more leavers than matches wanted to remain in their current placement, while fewer leavers than matches said there was nothing they liked about their current placement. More leavers than matches found their medication helpful.

The TAPS project. 6: New long-stay psychiatric patients and social deprivation.

The clinical and social characteristics of new long-stay (NLS) patients at Friern and Claybury hospitals are described, together with their accumulation rates within health districts in northeast London, and the associations between accumulation rates and social deprivation. There is a fourfold variation between local districts in annual accumulation rates of NLS patients (between 2.5 and 11 per 100,000 population); 0.55 of this variation is accounted for by the Jarman scores of social deprivation, and 0.81 by local rates of unemployment. Other recent British studies support this finding that measures of social deprivation can statistically explain a large proportion of the variation in treated rates of psychiatric morbidity, and may be useful in predicting needs for psychiatric services.

The TAPS project. 3: Predicting the community costs of closing psychiatric hospitals.

The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of these resource requirements has had to proceed in a vacuum. By examining the costs of community reprovision for the first 136 people to leave Claybury and Friern Hospitals, a prediction equation has been estimated from existing data which links the hospital-assessed characteristics (including psychiatric symptoms and behavioural problems) of these people to the subsequent cost of community care. About a third of the observed variation in these costs can be explained statistically by these 'baseline' characteristics. However, the first cohorts exhibit fewer behavioural problems and other symptoms of mental illness, they have been in hospital for shorter lengths of time, and they are younger. The prediction equation for the leavers is thus used to extrapolate community costs for those hospital residents yet to leave. It is found that community costs are lower than hospital costs, not just for the first cohorts of leavers, but for the full populations of the two hospitals scheduled to close.