A Systematic Review of Outcomes for People With Intellectual Disabilities and/or Autistic People Following Resettlement From Long-Stay Hospitals in the UK.
Zoe Rubenstein, Jon Glasby, Rachel Posaner and 2 others
Most included studies found some improvement after people left hospital, but gains were not universal, often levelled off within a few years, and many people still had smaller networks, less community participation, and more restrictive lives than comparable populations.
Key findings
1The majority of included studies reported general improvements in quality of life, skills, and community participation after resettlement, but these improvements were not universal and tended to level off after the first few years.
2Over half the included studies did not include the views of the people themselves, and studies that relied on proxy respondents tended to report larger quality-of-life gains than studies that asked people directly.
3Most of the evidence comes from the closure of historic asylums in the 1990s; only three studies examined outcomes for people leaving contemporary long-stay hospitals.
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How it was doneWhat they foundWhat it means for OTs
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What it does not show
Most of the included studies relate to the closure of historic asylums in the 1990s; only three examined outcomes for people leaving contemporary long-stay hospitals, so the findings may not reflect current service models. Over half the included studies did not include the views of the people themselves, and many relied on proxy respondents, which the authors note tends to produce more optimistic quality-of-life ratings. The authors did not conduct a systematic quality appraisal of the included studies, instead noting informally where claims were or were not supported by the text. There was little meaningful discussion of ethnicity across the included studies, and no discussion of whether outcomes differ for people with intellectual disabilities compared to autistic people or those with a combined diagnosis. The included studies used a wide range of outcome measures and methods, making it difficult to identify clear patterns around specific outcomes. The review is limited to the UK, so findings may not generalise to other countries.
Declared interests
The work was supported by the NIHR School for Social Care Research. The authors note that Changing Our Lives, a rights-based organisation, is sometimes funded by the NHS to work with people in long-stay hospital settings to help them plan support after hospital. The authors state they have nothing else to report.
The easy way to misread this
Do not read the general improvement finding as evidence that resettlement reliably works. Most of the evidence comes from the 1990s asylum closures, only three studies examined contemporary hospitals, and over half the included studies did not ask the people themselves how they were doing. Where people were asked directly, improvements were often smaller or absent.
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