Deinstitutionalization’s Impact on Chronic Psychiatric Patients’ Social Functioning: a Study using Hall and Baker’s Rehab Rating Scale

Abstract

Aims:

To assess the possible impact of deinstitutionalization on the social behaviour of chronic psychiatric patients.

Methods:

Hall and Baker's REHAB is a comprehensive behaviour rating scale designed to assess social functioning of people with a major psychiatric disorder. REHAB was completed for 58 chronic psychiatric patients (41 men - 17 women, mean age: 57.5±12.5 years) independently by a pair of raters one year before and another pair of raters one year after the patients’ relocation.

Results:

Among REHAB's five subscales that assess patients’ general behaviour, “community skills” and “social activity”, showed statistically significant improvement (p< 0.001 for both subscales), “self-care” and “overall impression” showed a mild but not significant change, while “speech disturbance” remained at almost identical levels. Gender was not associated but age correlated negatively with patients’ level of functioning (p=0.009). Regarding REHAB's section that assesses patients’ deviant behaviour, there was a significant decrease in the severity and/or frequency of patients’ self-talking (p=0.021) and a slight non-significant change in patients’ exhibiting physical violence, self-injurious or sexually offensive behaviour; nevertheless it is important to note that 40%-83% of the patients did not present with deviant behaviour to begin with. Gender did not influence results, but physical violence, self-injury and verbal aggression showed moderate negative correlation with age (r=-0.341 to -0.435).

Conclusions:

Even though deinstitutionalization does not improve every aspect or psychiatric patients’ social functioning, it reasonably enhances social and community skills and suppresses some of their deviant behaviours.