Like most mental hospitals across India, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru has long-stay patients who are in the hospital ward for many years because they do not have a family or a place to go back to. This is in spite efforts to place them in agencies and homes outside the hospital. In many instances, the hospital has made multiple attempts to trace the families of these patients, albeit unsuccessfully.

Facilitating Aadhaar and Voting for Long-Stay Patients: Experience from a Tertiary Care Center:

The length of stay (L.O.S.) in psychiatric inpatient units has become increasingly relevant as external pressures for economic justification of this expensive treatment modality have reinforced clinical and research misgivings about possible adverse effects of hospitalization (Krishner 1982). In a country like India, where the number of psychiatric beds is 0.03 to 0.04 per thousand population, there is a great need to keep hospital stay short. In the past, mental hospitals offered only life long custody, restraints and seclusion. Even after the advent of antipsychotics, many large state hospitals remained poorly staffed, over crowded and occupied by many chronic patients for whom no active treatment had been available. The separation of these patients from their families, the distance from community of origin and the consequences of long term institutionalisation all contribute to the condition from which they suffer (Wing 1962). Due to the almost revolutional progress in the treatment of mental illness, modern mental hospitals have discarded old custodial outlooks and have converted themselves into therapeutic centres. Whatever be the nature of the mental hospital, there are a good number of chronic patients who stay a long time in them (WHO Report 1978).

The length of stay of psychiatric inpatients.

The patterns of admission in a State Mental Hospital during the past decade (1st January 1973 to 31st December 1932) was studied. It was observed that voluntary admissions gradually increased whereas certified admissions declined over the decade. The certified cases from Madras City showed a decline in the recent years after some fluctuations and the certified cases from Districts of Tamil Nadu remained almost constant throughout the decade. The admissions from Madras City increased whereas the admissions from the Districts of Tamil Nadu showed a tendency to decline. The reasons for the above observations are discussed.

Changing patterns of admission in a state mental hospital.

Life table method was presented as a method of choice to analyse data arising out of longitudinal studies. The method was employed to study length of stay (LOS) of psychiatric in-patients. The result obtained was compared with LOS calculated by traditional methods. The LOS was 58-60 days computed by traditional methods for the year 1985 for our centre. This was shown by the life table method as the expected LOS at the time of admission. The life table method demonstrated that the rate of discharge increased as the length of stay increased upto 30 days and decreased afterwards. On the other hand, the expected further LOS increased as the length of stay increased upto 3 years. The implications of the findings were discussed.

An application of life table method in the study of length of stay.

A single day census found that long-stay patients (LSP) numbering 7,307 accounted for about 48% of the total inpatient strength of 15,345 in government mental hospitals in India. A load of 2695 (37%) LSP were in two to five years duration of stay, 2782 (38%) were in five to fifteen years duration of stay, and the remaining 1830 (25%) were staying for more than fifteen years. About 11% of LSP were aged sixty years and above, majority (53%) were males, non-voluntary cases constituted 80%. and more than two-thirds (69%) were schizophrenics. The characteristics distributions associated with high rates of LSP at individual hospitals were identified. The load of LSP was decreased by 9% during the period from 1993 to 1999.

A census of long-stay patients in government mental hospitals in India.

A study of the long stay patients in a state mental hospital on 30th June 1980 revealed that 70 per cent of the total 1,434, i.e. 1015 had spent more than two years continuously; most of them are chronic schizophrenics, admitted by the police, lacking social support. The need for rehabilitating them both within and outside the hospital is stressed.

O Somasundaram

Papers

Long stay patients in a state mental hospital.