Psychological Medicine

Original Articles

Difficult to place patients in a psychiatric hospital closure programme: the TAPS project 24

Noam Triemana1 c1 and Julian Leffa1

a1 Academic Department of Psychiatry, Royal Free Hospital School of Medicine; and MRC Social and Community Psychiatry Unit, Institute of Psychiatry, London


A group of 72 long-term patients, who were retained in Friern Hospital until the final stage of its closure programme, underwent a comprehensive psychiatric and social assessment shortly before moving to other hospitals. These patients were then compared with the rest of the long-stay patients who were considered suitable for community placement.

The residual group consisted of younger patients with shorter duration of stay, compared with the rest of the hospital population. Although not excessively disabled functionally or physically, the residual patients were slightly more disturbed in mental state in comparison with the rest, with notably higher levels of subjective anxiety.

A range of 13 problem behaviours were designated by staff as a direct impediment to placing a patient in a community setting. Most common problem areas were aggressiveness, non-compliance with medication and inappropriate sexual behaviour. Fourteen per cent of the residual group had none of these special problems. Some other patients have remained in hospital solely because they refused to leave.

It is argued that a distinction should be made between the residual patients who were actually transferred to other hospitals, and a core group of extremely disturbed patients for whom further hospitalization is likely to be the only alternative.


c1 Address for correspondence: Dr Noam Trieman, TAPS Research Unit, 69 Fleet Road, Hampstead, London NW3 2QU.