One and two year outcomes for adults with learning disabilities discharged to the community

Background. Long-stay patients with learning disabilities (n=214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation. Method. Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation. Results. There was little or no change in people's low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P less than or equal to 0.01) 12 months after discharge (n=119) and were more satisfied (P less than or equal to 0.05) with their new 'homes' (n=108). There were few changes in the pattern of a activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge. Conclusions. The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of 'ordinary' accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.