Schizophrenia is a long-term, chronic, illness with a worldwide lifetime prevalence of about one per cent. It has a high disability rate and the cost to individuals, their carers and health services is substantial. Although the majority of people with schizophrenia learn to cope in the community, there are some people who need help and reminders if they are to manage self-care and other aspects of day-to-day living. In many countries these people end up as long stay patients on hospital wards. This review aims to look at the economic costs and quality of life of people in 24 hour non-hospital care compared to those still in hospital. Only one trial of 22 people and lasting two years was identified, and it took place in the UK. Most of the participants but not all had schizophrenia. Half were assigned to live in a house staffed by a psychologist, and enough nurses and nursing assistants to provide 24 hour care. The staff were expected to help prepare and share meals with the residents and the residents had a programme of domestic work and some self-care tasks. The psychologist worked with each individual to improve social interaction and behaviour. The control group had normal hospital care with access to occupational therapy, industrial therapy and recreational facilities. They were also allowed home on leave and were counted as part of the group if they were discharged, transferred to hostels or in prison. The majority of the data were difficult to interpret because the numbers needed to make statistical comparisons were not given. Three people from the house had to be readmitted to the hospital and several of the others had short stays there. Those people who were resident in the house were reported to be significantly more likely to use social facilities and spent more time in socially constructive activities (self-care, eating with the group). All other measures reported were not significantly different between the groups. The costs for each group were similar, however if cost was calculated for those in the house who did not use the hospital at all, it was slightly less expensive. This was a small study which was not designed well. A larger, well-designed trial would answer the question of whether 24 hour care would benefit this group of people.
(Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org).