Patients' readiness for deinstitutionalization: objective evaluation vs. subjective views of staff, relatives and patients themselves

Background

Deinstitutionalization decisions are usually influenced not only by objective evaluations but also by subjective views of the parties involved.

Materials and methods

Community Placement Questionnaire (CPQ) was completed for 278 patients prior to the implementation of the deinstitutionalization project in the Psychiatric Hospital of Petra, Olympus, Greece. The staff's, relatives' and patients' views were also recorded.

Results

Considering CPQ to be the golden standard, the staff's evaluations of patients' readiness to be deinstitutionalized were more accurate [F(2,268) = 51.67, p < 0.001], while relatives had exactly opposite views [F(2,231) = 4.13, p = 0.017]. In general relatives expressed more optimistic estimations than patients or staff; however their enthusiasm was diminished [x2(2) = 8.86, p = 0.012], if the patients had already tried and failed to live outside the institution. Patients who were confined by court order felt less ready to go out than patients who were voluntarily committed [x2(6) = 16.43, p = 0.012]. Finally, when staff suggested the restrictiveness of a structure, they took more in account their own evaluations about the patients' readiness, his/her age and the duration of his/her last hospitalization, than the patients' or their relatives' views.

Discussion

The staff's evaluations about patients' readiness to be deinstitutionalized and their suggestions for ideal future community structures for them seem to be accurate, objective; they are not influenced by patients' or relatives' views.