Autonomy of long-stay psychiatric inpatients

Luciane Carniel Wagner,Mário Wagner,Míriam Thaís Guterres Dias,Marcelo Pio De Almeida Fleck

doi:10.1590/s0034-89102006000500021

Abstract

To assess personal autonomy of long-stay psychiatric inpatients, to identify those patients who could be discharged and to evaluate the impact of sociodemographic variables, social functioning, and physical disabilities on their autonomy was also assessed. A total of 584 long-stay individuals of a psychiatric hospital (96% of the hospital population) in Southern Brazil was assessed between July and August 2002. The following instruments, adapted to the Brazilian reality, were used: independent living skills survey, social behavioral schedule, and questionnaire for assessing physical disability. Patients showed severe impairment of their personal autonomy, especially concerning money management, work-related skills and leisure, food preparation, and use of transportation. Autonomy deterioration was associated with length of stay (OR=1.02), greater physical disability (OR=1.54; p=0.01), and male gender (OR=3.11; p<0.001). The risk estimate of autonomy deterioration was 23 times greater among those individuals with severe impairment of social functioning (95% CI: 10.67-49.24). In-patients studied showed serious impairment of autonomy. While planning these patients' discharge their deficits should be taken into consideration. Assessment of patients' ability to function and to be autonomous helps in identifying their needs for care and to evaluate their actual possibilities of social reinsertion.

Highlights

Over the last century the world has witnessed great improvements in mental health care: development of psychotropic drugs, replacement of the hospitalcentered model with community care aiming at patients’ comprehensive care and their social reinsertion.[4]
This remaining population mostly comprises chronic patients who became incapable to socially interact again.[18]. Such patients represent one of the greatest challenges to deinstitutionalization – their severe disabilities make them in need of constant social support and care. An assessment of these individuals’ personal autonomy and daily life skills is needed before their discharge to provide them with more appropriate care
Most inpatients had been hospitalized for quite a long time; non-significant predominance of women (54%); mean age of 55 years; 81% were near-illiter

Summary

Introduction

Over the last century the world has witnessed great improvements in mental health care: development of psychotropic drugs, replacement of the hospitalcentered model with community care aiming at patients’ comprehensive care and their social reinsertion.[4]. Worldwide, there still remain the so-called exclusive psychiatric institutions and their institutionalized patients. This remaining population mostly comprises chronic patients who became incapable to socially interact again.[18] Such patients represent one of the greatest challenges to deinstitutionalization – their severe disabilities make them in need of constant social support and care. An assessment of these individuals’ personal autonomy and daily life skills is needed before their discharge to provide them with more appropriate care. The lack of systematic assessments of this process in developing countries[8] means that many patients are being discharged without prior appropriate assessment of their dependency levels and planning for their care

Methods

Results

Conclusion