Rickard, Colin John; (1997) A study of the community reprovision programmes of the psychiatric institutions in England 1993-1995. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The reprovision of services in the community previously provided by psychiatric hospitals in the UK has taken from less than five to more than ten years to achieve for each hospital so far closed. Many psychiatric hospitals remain at least partially open. Protracted closures incur substantial double running costs to maintain both community and hospital reprovision. Purchasers should bring all possible pressure on providers to reduce the duration of closure programmes in an effort to reduce these costs to a minimum. There is concern that rapid implementation of closure plans will result in the use of expedient, and possibly, sub-standard facilities, too little time to explain plans to all interested parties (patients, families, staff, local communities), and thus rapid closure plans may be seen as low quality. The research tested the hypothesis: - "Planned short closure programmes can be achieved without detriment to the quality of reprovision". A database of all the English psychiatric hospitals, identifying those reproviding services in the community with a view to closure, was set up to map their progress over three years. Key steps associated with successful programmes from a macro-level, planning perspective were identified. Three psychiatric hospitals' reprovision programmes were monitored in detail to provide a micro-level study of the quality of reprovision from patient, family and staff perspectives. The National study found that 24 (41%) of psychiatric institutions open in 1995 had no agreed plans for reprovision in the community and at least 25 would still be open after the year 2000. Major capital schemes were a major determinant of programme length and only 40% of programmes completed on time. All hospitals studied were acquiring more complex case mixes and higher staff patient ratios whether they were closing or not. There were wide variations in both the level of reprovision and the rate of closure of psychiatric institutions between the English health regions. The case studies of closures shorter than the national average programme length, found no harm caused to patients, acceptable physical reprovision standards and that patients, staff and relatives found the outcome satisfactory. The conclusions reached were that short closure programmes can be satisfactory implemented, inadequate management control and uncertainty of funding were major contributors to delays in implementation.

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