Characteristics of patients needing long term care

Diagnosis

With the exception of the elderly most psychiatric patients requiring long-term care have schizophrenia, chronic affective disorders, presenile dementia, or personality disorders associated with aggressive behavior or substance misuse. Patients who need care in hospital for more than a year are sometimes referred to as the 'new long-stay' (in contrast with the 'old long-stay' who had been resident in hospital for many years before hospital closure programs were initiated).

Problems

There are several ways of classifying the problems of patients who need long-term psychiatric care. One used approach is to divide the problems into seven groups, three of which are contained in the World Health Organization classification of disablement.

•  Symptoms such as persistent hallucinations, or suicidal ideas;

•  Unacceptablebehaviours such shouting obscenities, and threatening or carrying out violent acts;

•  Impairments which are interferences with the functioning of a psychological or physical system, for example, poor memory or lack of drive;

•  Disabilities which are interferences with the activities of the whole person, such as inability to dress;

•  Handicaps which are social disadvantages consequent on disability, for example, inability to work, or to care for children;

•  Other social disadvantages not directly related to disability, such as employment, poverty, and homelessness consequent on the stigmatizing attitudes of other people;

•  Adverse personal reactions to illness and social disadvantage, such as low self-esteem, hopelessness, denial of illness, or the misuse of drugs.

Wing and Furlong proposed a useful list of pacient characteristics that make it difficult to treat them in the community. Patients with severe and persistent problems of this kind need care in a well-staffed hostel, or in hospital which can provide appropriate rehabilitation and security.

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