Objective: To investigate the cost-effectiveness of the first psychiatric long-stay care home in Hong Kong, which opened in 1990.
Methods: This was a prospective cohort study of the first 43 patients discharged to the long-stay care home from Castle Peak Hospital, who were followed-up for 2 years.
Results: Patients had significantly improved social and community skills while remaining behaviourally and symptomatically stable. The long-stay care home provided a less restrictive environment than Castle Peak Hospital, and patients' satisfaction was high. The recurring costs for the long-stay care home were lower than for the hospital. The only statistically significant adverse finding was deterioration in personal health care skills 2 years after leaving the medical setting.
Conclusion: This study provides the first scientific evidence in Hong Kong to show that the long-stay care home is a cost-effective means of successfully rehabilitating a group of long-stay mental hospital inpatients who do not qualify for halfway houses but require only minimal nursing care (less than 2.5 hours per week).
Key words: Chronic mental illness, Community care, Deinstitutionalisation, Evaluation, Long-stay care home
Despite the current enthusiasm for shifting the emphasis of psychiatric care from hospital to the community, mental hospitals have continued to accumulate a number of long-stay patients. (1-4) Even when long-stay patients have been discharged from hospital, there is evidence to suggest that few achieve full independence from hospital services. (5) Furthermore, studies of community facilities such as hostels, halfway houses, and group homes have reported that the selection policies may exclude the more severely disabled or disturbed patients. (6-9) Remaining in hospital for long periods results in both clinical and social disadvantages for patients with chronic psychotic illness. The social milieu, particularly on an acute admission ward, may become too emotionally arousing and cause them to relapse with florid symptoms. The needs of these patients may be overlooked by the staff when their attention is distracted by the demands of floridly disturbed and newly admitted patients. Furthermore, long hospital stay may progressively disable a person from life in the community when the social milieu and management practices of a ward prevent patients from being responsible for domestic tasks such as cleaning, cooking, and laundry, as well as outside activities such as shopping and gardening. (10)
THE HONG KONG SCENE IN 1990
In Hong Kong, overcrowding in mental hospitals has been a problem for decades. Castle Peak Hospital (CPH), the oldest and largest mental hospital in Hong Kong, which was originally planned for 1242 patients, had 1933 beds in 1990. This was achieved by placing 1 extra bed in between every 2 beds, so that patients climbed onto the beds from the end of the bed instead of from its sides. However, the actual number of inpatients was 2251 by 31 December 1990. This was achieved by moving the furniture out of day rooms and dining rooms every night and putting in 'camp beds' for patients to sleep on, only for these rooms to be refurnished the next morning.
A significant proportion of patients at CPH were long-stay patients who had increased in number over decades. An internal survey of CPH conducted on census day in 1987 revealed that 56% of the inpatient population (more than 1000) had been in CPH for more than 2 years. Another internal survey revealed that more than 400 long-stay patients should be stable enough to be discharged to a long-stay hostel in the community rather than staying indefinitely in a mental hospital. However, the fact was that no long-stay care home for these patients existed in Hong Kong prior to 1990. Figure 1 shows a conceptual spectrum of residential services for mentally ill persons in Hong Kong. …