There is a lot of literature on this issue from Britain

I have copied few references here. There is a series of papers fromTAPS project.

Long-stay patients discharged from psychiatric hospitals Social and clinical outcomes after five years in the community. The TAPS Project 46

J Leff, N Trieman - The British Journal of Psychiatry, 2000 - RCP

Background There have been no large-scale prospective studies evaluating the transfer of care from psychiatric hospitals to district-based services. Aims We aimed to compare the quality of life of patients in two north London hospitals scheduled for closure with that in ...

Cited by 123 Related articles More

[PDF] Team for the Assessment of Psychiatric Services (TAPS) Project 33: prospective follow-up study of long-stay patients discharged from two psychiatric hospitals

J Leff, N Trieman, C Gooch - American Journal of Psychiatry, 1996 - Am Psychiatric Assoc

Objective: The purpose of this study was to evaluate the policy of closing psychiatric hospitals and replacing their functions with community-based services. Method: All long-stay nondemented patients in two UK hospitals scheduled for closure were assessed with a ...

Cited by 102 Related articles More

The TAPS project: VIII. Design of the research study on the long-stay patients.

C O'Driscoll, J Leff - The British Journal of Psychiatry, 1993 - psycnet.apa.org

Abstract 1. Describes the origins of the Team for the Assessment of Psychiatric Services (TAPS) project and the design of the prospective study of the long-stay patient populations of 2 large mental hospitals in north London scheduled for reprovision and closure by the ...

Cited by 66 Related articles More

The TAPS project: XIII. Clinical and social outcomes of long-stay psychiatric patients after one year in the community.

J Anderson, D Dayson, W Wills… - The British Journal of …, 1993 - psycnet.apa.org

Abstract 1. As part of the Team for the Assessment of Psychiatric Services (TAPS) project, this study compared clinical and social outcomes for 278 long-stay psychiatric inpatients who were discharged from the hospital and 262 long-stay psychiatric inpatient controls ( ...

Cited by 76 Related articles More

The TAPS Project. 22: A five-year follow-up of long-stay psychiatric patients discharged to the community.

JP Leff, G Thornicroft, N Coxhead… - The British Journal of …, 1994 - psycnet.apa.org

Abstract 1. The Team for the Assessment of Psychiatric Services (TAPS) assessed a group of 114 long-stay patients in 2 psychiatric hospitals while in the hospital, and then again 1 and 5 yrs after discharge to community placements. Measures used were the Present ...

Cited by 87 Related articles More

Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community TAPS Project 44

N TRIEMAN, J LEFF - The British Journal of Psychiatry, 2002 - RCP

Background Whereas the majority of long-stay in-patients have been successfully resettled in the community, there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes. Aims To study the long-term outcome of a group ...

Cited by 64 Related articles More

The TAPS project. 3: Predicting the community costs of closing psychiatric hospitals.

M Knapp, J Beecham, J Anderson, D Dayson… - The British Journal of …, 1990 - RCP

Abstract The planning of long-term care in the community as an alternative to in-patient care requires accurate information on the likely expense of altering the balance of provision. Unfortunately, as very few long-stay psychiatric hospitals have yet closed, the planning of ...

Cited by 77 Related articles More

The TAPS project: VII. Mental hospital closure: A literature review of outcome studies and evaluative techniques.

C O'Driscoll - The British Journal of Psychiatry, 1993 - psycnet.apa.org

Abstract 1. Reviews the literature on outcome studies of deinstitutionalization and mental hospital closure with particular reference to the UK, the US, and Italy. Data from these studies are discussed in terms of their influence on the design of a new study to evaluate ...

Cited by 54 Related articles More

The TAPS Project A report on 13 years of research, 1985-1998

J Leff, N Trieman, M Knapp, A Hallam - Psychiatric Bulletin, 2000 - RCP

The Team for the Assessment of Psychiatric Services (TAPS) was established in May 1985 with the explicit purpose of evaluating the national policy of replacing psychiatric hospitals with district based services. TAPS'remit was to mount the evaluation with respect to the ...

Cited by 60 Related articles More

The TAPS Project. 4: An observational study of the social life of long-stay patients.

M Dunn, C O'Driscoll, D Dayson, W Wills, J Leff - The British Journal of …, 1990 - RCP

Abstract Observations of long-stay patients in a club in a psychiatric hospital were carried out unobtrusively over several months. Much of the social activity that went on was stimulated by an economy based around the purchase and exchange of tea and ...

The TAPS project. 3: Predicting the community costs of closing psychiatric hospitals.

M Knapp, J Beecham, J Anderson, D Dayson… - The British Journal of …, 1990 - RCP

Deinstitutionalisation--from hospital closure to service development.

G Thornicroft, P Bebbington - The British Journal of Psychiatry, 1989 - RCP

Original Article

Out of the wards and onto the streets? Deinstitutionalization and homelessness in Britain

1992, Vol. 1, No. 3 , Pages 265-275

PDF (795 KB)

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Tom Craig1† and Philip W. Timms1

1United Medical & Dental Schools, St Thomas's Hospital, Lambeth Palace Road, London, SE1 7EH

Read More: http://informahealthcare.com/doi/abs/10.3109/09638239209005459

Cited by 29 Related articles More

[C] Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality (Cochrane Review)

P Tyrer, J Coid, S Simmonds, P Joseph, S Marriott - The Cochrane Library, 2003

Deinstitutionalization, social rejection, and the self-esteem of former mental patients

ER Wright, WP Gronfein, TJ Owens - Journal of health and social behavior, 2000 - JSTOR

A public hospital closes: impact on patients' access to care and health status

AB Bindman, D Keane, N Lurie - Jama, 1990 - jama.jamanetwork.com

Many thanks Muhammad for your helpful reply

Hi Camelina

Thanks for this reference I was not aware of this project. We had very similar evidence from the TAPS project here in England studies led by Julian Leff in the main. However, these studies ceased about ten years ago and we are concerned that in the intervening period this group have been subsequently neglected either being shunted off into private residential accommodation or worse............

Thanks again Charlie

Here's a 1999 article on the closure of a large state psychiatric hospital in Philadelphia, PA USA:

The Impact of Closing a State Psychiatric Hospital on the County Mental Health System and Its Clients

Edna Kamis-Gould, Ph.D.; Fredrick Snyder, M.A.; Trevor R. Hadley, Ph.D.; Timothy Casey, M.A.

Psychiatric Services, VOL. 50, No. 10

This three-year study examined the impact of closing a state psychiatric hospital in 1991 on service utilization patterns and related costs for clients with and without serious mental illness.

http://ps.psychiatryonline.org/article.aspx?articleid=83447

Many thanks....evidence here that closing a psychiatric hospital and replacing it with a community-based service saved a significant amount of money for a period up to three years after closure. We're interested in how long this momentum was maintained, for example, some private residential placements in England are now costing £125,000 per annum. This is before we ask the question and what is the quality of those placements.

Mr Brooker,

I am not much help with the studies in the UK.

I have lived the process here in the US. I am schizoaffective and lived on the streets for over ten years. I have experienced and heard of many sad and desperate things during these many years. My 1st doctors appointment was in 1969. I was not accurately diagnosed until 2000. I could not have been any more obviously in the bipolar spectrum of disorders, yet I fell through the cracks. Experiencing decades of wreckage and having to work to overcome it daily fuels the effort I put into the men and women I work with today to help them avoid the problems I experienced.

I live in Texas and Texas is in the bottom handful of states in funding programs for the mental health population. The outpatient clinics are divided between two systems: managed care and socialized care.

Socialized care provision is the vast majority of the MH care in Texas. 247 out of 254 counties are controlled by this system. The individual counties have budgets and directors that who decide the policies to spend that funding. These providers have a huge government lobby and are deeply entrenched politically. And even though they have unacceptable wait times and other deplorable performance issues it is virtually impossible to do anything about this system, particularly when the consumers are most often unable to advocate for themselves in any way.

Managed care is available in 7 counties called the NorthSTAR area. The clinics are private and compete for the consumers by providing better services. There are definite problems to be sure. But the benefits have been evident in the huge savings and the reduction of wait times to 24 hours. I forget the numbers, but the amount of services delivered for the buck in NorthSTAR is far greater than in the socialized system. But unfortunately there is no competing with the powerful lobby so expansion of managed care seems unlikely.

The sad reality in my experience and research is that most people enter the mental health system in the US through the courts. Jails are the largest mental health providers in the US now. The saddest thing about this is that those who are in the business of depriving people of their freedom are not often in any position to help nor do they have the inclination to help those they confine. They are rightly most concerned with behavior and obedience. Simply put the new asylum in the US is a prison or county jail and the main treatments are the harsh brutalities of the jailers, the environments and the other inmates.

I hope this provides some insights from a man who has been there. Contact me if you like.

Thanks, Chris, for taking the time to write such a fulsome response - it's appreciated. The system in Texas sounds highly problematic. Here in the UK the large psychiatric hospital closure plan peaked around 1994. In the two decades since, policy makers have not really got a grip on the outstanding issues, like homelessness, like rehabilitation programmes, like the high proportion of people in prison with a mental health problem. There was a fad, through the National Service Framework, to invest in evidence-based practice, for example, Assertive Outreach, was more or less directly imported from the US. However, AO personnel were those that had been providing rehab services so these largely went out the window. Now our mental health service systems are being cut (modernised) year on year and there is enormous pressure on acute beds. Partly the lack of rehab services mean that people who are unable to live unsupported 'block' acute. beds and CMHTs are being pressurised to return to some kind of rehab function.

Dear Mr. Brooker,

Thank you for your kind note and efforts. It is a similar case here. The pressure to provide a guarantee of outcome is driving these ebp actions. Of course the problem is the model itself. The medical model trains the people with mental health disorders to accept that they will be limited by their disorder for the entirety of their life and should expect a lifetime of government care. the medical model is disease or disorder care. The recovery model transfers the onus to the consumer. I present the two options to my clients clearly- if they are pleased with a life of definite limited growth and truncated opportunities controlled by the budget cycle of the state then we part friends and I point them to the existing programs. If they are interested in something else then I will show them what I know- how to build a life. In 2007 a well meaning and compassionate psychiatrist told me that the best I could ever hope for was to collect a government check and live in government housing. My life is nothing like that today. I take these same hard learned skills on how to build a support group within the community of resources that is available and teach it to my clients. The principles of recovery say that though I have developed or inherited serious problems, that have created major wreckage in my life, there is a systematic path to a productive life. Not everyone is able to achieve independence. Then it is a matter of helping them find the community of interests, including government support, that will help them reach as many goals as possible.

Beds are difficult to come by. Often the replacement for acute beds formerly provided in an institutional setting is the community group home with acute beds. The placements are made by various agencies or family members. The cost is born by the state insurance. This provides a small business stimulus and helps eliminate the unhealthy institutionalization of consumers. The down side is that many of these homes are owned or operated by unqualified people in undesirable parts of town. The recent criminal sprees involving people with mental health histories have made it difficult to have a community home that is accepted in a better part of the community. To be blunt- people with mental health disorders are often feared. This is the characterization of our media and there is little information to present the truth. A more accurate representation would be that people with mental health disorders are more likely to be victims than perpetrators.

So this is the landscape where we find ourselves deployed. We are behind in funding, public opinion & perception, and in an effective therapeutic model. It is a daunting task to challenge the forces that would frankly rather see us defectives eliminated from view for the common good. However I can help you I will. I realize that it is not that often one finds a person who has both lived this life and is willing to discuss it.

Best Regards,

Chris Moore