The first thing that struck me was the extraordinary level of institutionalisation.
Only where patients were subject to guardianship was there a significant association with an increased level of institutionalisation. Our study suggests that the level of institutionalisation and the associated costs of welfare housing services do not accurately reflect the severity of illness or the level of functional impairment of the patients there are designed to support.
While this housing differed largely in the level of institutionalisation and also in the costs of accommodation, these differences were not related to a patient's severity of disease or in their functional impairment.
Richter found that the level of institutionalisation was positively related to the level of impairment measured by HoNOS but that the subjective quality of life was similar in all groups.
However, they also found that the chance of the residents being discharged from their current residential facility and switching to a facility with a lower level of institutionalisation was rather small and difficult to predict on the basis of the individual level of impairment [ 8, 9].
Although the results of all the studies discussed above indicate that the level of institutionalisation in residential care is positively related to the level of impairment, no study has compared the level of impairment between patients in residential care with that of patients who live more independently in different housing settings in the community.
Given the fact that an inadequate level of institutionalisation in mental health care causes on the one hand unnecessary restricts patients' freedom and on the other hand adds unnecessary costs to society, it seems essential to investigate which of these explanations is true, especially because of the challenge of dealing with adequate care of new long-term residential patients [ 24, 25].
A degree of institutionalisation is needed.
There must be a degree of institutionalisation, albeit pampered institutionalisation – in all sport, leading players are routinely instructed in every detail of their lives, what to wear, when to be where, and what to say to the media.
Table 6 describes the predictive power of frailty syndrome models to predict discharge to a higher level of support (institutionalisation; range of AUCs 0.63 0.654).
