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The TAPS Project. 36: The Most Difficult to Place Long-Stay Psychiatric In-patients: Outcome One Year After Relocation

  • Noam Trieman (a1) and Julian Leff (a1)



The clinical and social outcomes were evaluated of “difficult to place” (DTP) patients discharged from hospital to alternative facilities.


In the course of a reprovision programme for a psychiatric hospital, 72 long-stay patients were considered to be too problematic to live within the usual range of community placements. Their clinical and social state was assessed shortly before the hospital closed. Severe, persistent behavioural problems were recorded for each subject at baseline. One year after being relocated, patients were reassessed.


Clinical and social measures were stable over time. The profile of severe behavioural problems changed over time, with one-third of the total problems subsiding and a similar number of new problems emerging. There was a significant reduction in physical aggression. One of the settings provided an environment as free of restrictions as the usual community homes.


The most difficult patients to reprovide for can be contained in a relatively non-restrictive care environment. There is some indication that aggressive behaviour can improve, raising the possibility that some DTP patients can move on to the usual community homes.


Corresponding author

Dr Noam Trieman, TAPS Research Unit, 69 Fleet Road, Hampstead, London NW3 2QU


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Beecham, J., Hallam, A., Knapp, M., et al (1995) The Economic Evaluation of Community Psychiatric Reprovision: Final Report to North Thames Regional Health Authority. London: North Thames Regional Health Authority.
Bennett, D. H. (1980) The chronic psychiatric patient today. Journal of the Royal Society of Medicine, 73, 301303.
Leff, J., Trieman, N. & Gooch, C. (1996) The TAPS Project 33: Prospective follow-up study of long-stay patients discharged from two Victorian asylums. American Journal of Psychiatry (in press).
O'Driscoll, C. & Leff, J. (1993) The TAPS Project 8: Design of the research study on the long-stay patients. British Journal of Psychiatry, 192(suppl. 19), 1824.
Trieman, N. & Leff, J. (1996) The TAPS Project 24: Difficult to place patients in the course of closing a psychiatric hospital. Psychological Medicine (in press).
Wing, L. (1989) Hospital Closure and the Resettlement of Residents. Aldershot Gower.


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The TAPS Project. 36: The Most Difficult to Place Long-Stay Psychiatric In-patients: Outcome One Year After Relocation

  • Noam Trieman (a1) and Julian Leff (a1)
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