Greece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.

Cet article traite des problèmes vécus par les families dont un proche parent réside dans un hôpital de soins aigus et se trouvent en attente de placement dans un établissement de soins prolongés. Les données ont été recueillies dans un grand hôpital universitaire de Toronto. On a demandé à 84 aidants, membres de la famille et des proches du patient, de décrire les problèmes qu'ils ont vécus à la suite de son hospitalisation. Les problèmes énumérés étaient d'ordre personnel, familial et se trouvaient directement reliés à la situation du patient, à l'hôpital. Les problèmes ont été analysés en fonction du statut des aidants: conjoint(e), enfant ou simplement parent. Plus encore que les autres catégories d'aidants, les conjoint(e)s ont eu tendance à faire état de problèmes financiers ou encore du sentiment de ne pas se sentir écouté(e) par l'équipe de soin. Quant aux enfants ou aux autres parents, ils ont été portés, plus que les conjoint(e)s, à signaler des problèmes reliés à la famille élargie et aux situations conflictuelles nées de leurs multiples rôles et responsabilités.

Objectives: Much has been written about the costs and cost-effectiveness of community care for people with learning disabilities resettled from long stay hospital care. However, comparatively little has been published about the cost of hospital services relating to the preparatory process before eventual resettlement and the disengagement of formal, sustained input from hospital staff. This study describes and costs the input provided by a hospital based multi-disciplinary team into the resettlement of adults with learning disabilities from long stay wards in Muckamore Abbey Hospital in Northern Ireland between 1996 and 1999 (n = 71).

Method: The study employs a retrospective survey design. Information about the nature and frequency of the input of each member of hospital multi-disciplinary team was collected for each former client. According to the level of professional resources expended during the resettlement process, each former client was then categorised into one of three categories. One case was then selected at random to represent each category. A summary of clinical information, a description of the resettlement process and an estimate of the cost of the process was provided for each case.

Results: Approximately 55% of people resettled in the community during the study period did so with a modest degree of input from hospital staff. For 18% resettlement proved to be a demanding and prolonged process, requiring intensive input from hospital staff. Financial costs of the resettlement process ranged from approximately stg£1,500 to stg£8,000, with an average of stg£3,400 for each person.

Conclusion: This study provides evidence of the input by hospital staff into the process of community resettlement of long stay hospital clients and the associated costs. These costs must be included in service budgets if quality care and appropriate service provision is to be maintained in resettlement practice.

Objectives: To describe an entire long-stay hospita population and examine the differences between the old and new long-stay groups. It outlines the communitybased facilities required for hospital closure to occur.

Method: One hundred and twenty-four patients were assessed using the Community Placement Questionnaire (CPQ), a standardised instrument used in service planning.

Results: The CPQ revealed a globally disabled group with multiple handicaps. The mean age was 68.7 years and the predominant diagnosis was schizophrenia. Though the old long-stay (74) were more disabled than the new long-stay (50), similar sheltered accommodation was required for both groups. The new long-stay required a more active day-care program.

Conclusions: Reprovision for long-stay patients must not only include sheltered accommodation but also appropriate day-care facilities. Assessment of the placement needs of all categories of long-stay patients necessary before hospital closure can take place.