Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa

摘要

OBJECTIVE: The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matchedthe national and international drive towards deinstitutionalisation. This article investigates patient and social work factors relatedto successful community placement, in the context of limited community care facilities. METHOD: Thirty-six long-term patientswho were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-termpatients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients receivedthe most interventions, and the most common type of interventions. RESULTS: The most significant patient factors associated withsuccessful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a lowfrequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), andagitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients duringthe study period: The recipients were mostly female, in open wards (higher-functioning); and the social services utilised weremostly related to planning for placement and patient support. CONCLUSION: The lack of community care facilities in the Pretoriaarea that are able to care for the more difficult long-term psychiatry patients, limits successful placement and increases the burdenof hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context ofprovincial and national health departments.