Closing the asylum : the changing face of care in a service for people with long-term mental health problems

In this thesis, reviews are carried out concerning the establishment of asylums, the reasons for their closure, and the methods that have been used to evaluate care quality in services for people with long-term mental health problems. The studies carried out attempt to evaluate care quality in a service moving from asylum to community-based care.;The first cross-sectional study comparing the care provided on the asylum ward and a community hostel suggested that institutional practices could be found in both. A second longitudinal study of the original asylum wards' closure and relocation to supported homes suggested that asylum closure could produce great turmoil. Although transfer to the community appeared to lead to some improvements in care, the study also highlighted how some of the measures used to determine care quality in asylums were less appropriate in community settings. A measure of interactions proved particularly useful in evaluating care in both settings and in two additional studies this was developed by using an event recorder and adding categories.;Given the changes in population seen in the longitudinal study of ward closure, a further comparative study was carried out on the asylum population's level of functioning over a six year period. Discriminant analysis suggested that the more able had moved into community settings, while individuals with challenging behaviour such as verbal aggression, had remained in the asylum. Older residents had either died or moved to homes for the elderly.;Over the eight years leading to the closure of the asylum evaluated in this thesis, there has been an increasing emphasis upon users' views. A cross-sectional study of subjective quality of life (comparing residents of a ward and people who had recently been discharged from the same ward) suggested improvements in subjective quality of life could follow a move to the community (although these differences were confounded by differences in the two populations).;A longitudinal follow-up of the original residents once discharged to the community suggested fewer differences but also indicated that the nearness of final closure may be affecting how individuals perceived their move to the community.