Evaluation of a special rehabilitation programme for patients who are difficult to place

Background: Difficult-to-place patients are left at the end of programmes of psychiatric hospital closure and need specialised services, the nature of which is still under debate. The aim of this study was to evaluate a rehabilitation programme specially designed for difficult-to-place patients in a psychiatric hospital undergoing closure. Method: Twenty-two difficult-to-place patients were identified and underwent a customised rehabilitation programme. Their outcome after 1 year was compared with that of a similar group of 64 patients from another psychiatric hospital who had not received the main components of the rehabilitation programme. Results: Compared with the control patients, the experimental patients showed a significant reduction in severe problems of social behaviour (p < 0.005) and a borderline significant increase in domestic skills (p < 0.06). Conclusions: The results support the value of individually planned behavioural programmes for difficult-to-place patients, combined with training programmes for the staff and rationalisation of medication regimes.