The closure of a mental hospital in Sweden

5 years of transition to district-based long-term care
  • Karina Dencker
  • Göran Långström
Original Articles
  • 44 Downloads

Summary

A political decision to decentralize psychiatric care in a county of Sweden was made in October 1984. This will lead to the closure of the county's only large psychiatric hospital. Short-term psychiatric care will be provided by three smaller hospitals in the county, while long-term care in hospital will cease completely and be replaced by district-based psychiatric services. All patients (n=199) in the large hospital's long-term unit were studied over 5 years of the transition period. The results showed that 42% of patients were discharged during the period, mainly to other institutions. Only 8 patients were provided with alternative types of care, such as group homes. Sixty-eight per cent of all patients died, most of them before being discharged (80% of the organically demented patients and 51% of the others). The mortality rate for patients with severely impaired activities of daily living (ADL functioning) was 92% for those who were also organically demented and 84% for the others. The patients who survived the 5-year period were mainly (80%) nondemented patients with relatively well-preserved ADL functioning, but with behavioural disturbances.

Key words

ADL Deinstitutionalization Elderly Mental hospital Mortality 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Asbaugh JW, Bradley VJ (1979) Linking deinstitutionalization of patients with hospital phase-down: the difference between success and failure. Hosp Community Psychiatry 30:105–110Google Scholar
  2. Bachrach L (1976) Deinstitutionalization: an analytical review and sociological perspective. Dept of Health, Education and Welfare, Rockville, MdGoogle Scholar
  3. Brauer E, Mackeprang B, Bentzon MW (1978) Prognosis of survival in a geriatric population. Scand J Soc Med 6:17–24Google Scholar
  4. Bråne G (1989) The GBS scale — a geriatric rating scale — and its clinical application. Doctoral thesis, Medical Faculty of the University of Göteborg, SwedenGoogle Scholar
  5. Clifford P, Charman A, Webb Y, Best S (1991) Panning for community care. Long-stay populations of hospitals scheduled for rundown or closure. Br J Psychiatry 158:190–196Google Scholar
  6. Cox DR, Oakes D (1984) Analysis of survival data. Chapman & Hall, LondonGoogle Scholar
  7. Crepet P (1990) A transition period in psychiatric care in Italy ten years after the reform. Br J Psychiatr 156:27–36Google Scholar
  8. Curson DA, Patel M, Liddle PF, Barnes TRE (1988) Psychiatric morbidity of a long-stay hospital population with chronic schizophrenia and implications for future community care. BMJ 297: 819–821Google Scholar
  9. Dencker K (1989) The closure of a major psychiatric hospital: reactions of the psychogeriatric nursing staff. Soc Psychiatr Epidemiol 24:156–164Google Scholar
  10. Dencker K, Gottfries CG (1991a) The closure of a major psychiatric hospital: can psychiatric in long-term psychiatric care be integrated into existing nursing homes? J Geriatr Psychiatry 4: 149–156Google Scholar
  11. Dencker K, Gottfries CG (1991b) The closure of a major hospital: characterization of the long-term population over one year at an early stage of deinstitutionalization. Soc Psychiatry Psychiatr Epidemiol 26:162–167Google Scholar
  12. Donaldson LJ, Clayton DG, Clarke M (1980) The elderly in residential care: mortality in relation to functional capacity. J Epidemiol Community Health 34:96–101Google Scholar
  13. Donaldson LJ, Jagger C (1983) Survival and functional capacity: three year follow up of an elderly population in hospitals and homes. J Epidemiol Community Health 37:176–179Google Scholar
  14. Fakhruddin AKM, Manjooran A, Nair NPV, Neufeldt A (1972) A five-year outcome of discharged chronic psychiatric patients. Canadian Psychiatric Association Journal 17:433–435Google Scholar
  15. Goldfarb A (1969) Predicting mortality in the institutionalized aged. Arch Gen Psychiatry 21:172–176Google Scholar
  16. Gottfries CG, Bråne G, Gullberg B, Steen G (1982) A new rating scale for dementia syndromes. Archives of Gerontology Geriatrics 1:311–330Google Scholar
  17. Greenblatt M (1978) Psychopolitics. Grune and Stratton, New YorkGoogle Scholar
  18. Harrell FE (1983) The PHGLM procedure. In Sugi supplemental library user's guide (ed. S. Joyner (SAS Institute Inc., Cary, NCGoogle Scholar
  19. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919Google Scholar
  20. Lawton MP, Lipton MB, Fulcomer MC, Kleban MH (1977) Planning for a mental hospital phasedown. Am J Psychiatry 134: 1386–1390Google Scholar
  21. Levene LS, Donaldson LJ, Brandon S (1985) How likely is it that a district health authority can close its large mental hospital? Br J Psychiatry 147:150–155Google Scholar
  22. Linn MW, Gurel L, Williford WO, et al. (1985) Nursing home care as an alternative to psychiatric hospitalization. Archives of Gerontology and Psychiatry 42:544–551Google Scholar
  23. Perris C, Kemali D, Stancati G, Amanti A (1984) Är den italienska reformlagen gällande psykiatrin mogen för motreform? Nordisk Psychiatrisk Tiddskrift 367–377Google Scholar
  24. Sandman PO (1986) Aspects of institutional care of patients with dementia. Doctoral thesis, Medical Faculty of Umeå University, SwedenGoogle Scholar
  25. Socialstyrelsen (1982) Psykiatrisk vård utan mentalsjukhus. Socialstyrelsen redovisar, no 8Google Scholar
  26. Thornicroft G, Bebbington P (1989) Deinstitutionalisation — from hospital closure to service development. Br J Psychiatry 155: 739–753Google Scholar
  27. Wing JK, Furlong R (1986) A haven for the severely disabled within the context of a comprehensive psychiatric community service. Br J Psychiatry 149:449–457Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Karina Dencker
    • 1
  • Göran Långström
    • 1
  1. 1.Department of Psychiatry and NeurochemistryUniversity of Göteborg, Mölndal HospitalMölndalSweden

Personalised recommendations