A STUDY OF THE TRANSFER OF LONG-HOSPITALIZED PATIENTS TO A CONVALESCENT SERVICE

For five months a staff group of psychiatrist, social worker, nurse and vocational counsellor worked closely with a group of 72 male patients, about 75% of whom had been hospitalized more than 5 years but who were currently able to maintain, with little supervision, a minimal social level of adjustment at least. The patients had recently been transferred from old buildings to a modern convalescent cottage. Twenty-six patients, who might otherwise have stayed indefinitely, did leave but others—or a total of 55 patients of the 72—actually were no longer receiving any active benefit from hospitalization. A differentiation seemed pertinent between chronicity of the illness itself and social chronicity in which the individual becomes adapted to a routine level of social functioning below his actual capacity. The culture of the state hospital seems to invite chronicity in the latter sense.

The study indicates some of the threads in this pattern—often implicit rather than explicit. Chief among them is perhaps the old conception of the state hospital's function to give shelter indefinitely to those for whom no obviously better plan is available in the community and who are not motivated to try.

The study suggests a concept of hospitalization limited to the continuing appropriateness of that service in terms of treatment and/or protection and some of the administrative means by which the social adjustment of the patient might then be stimulated to keep pace with the expectation of future plans to live outside.