International review of deinstitutionalisation outcomes shows gains in quality of life but poor responses to health care needs


As long ago as 1994 Emerson and Hatton produced a review of UK literature on the outcomes for people with learning disabilities leaving long stay institutions (Emerson E & Hatton C (1994); Moving Out: Relocation from Hospital to Community) which involved 2,350 service users.

The findings of this review of international studies nearly twenty years later are remarkably similar This review looked at 15 studies examined assessing quality of life as a key outcome.

The researchers found that whilst the move from institutional care to community based living had produced generally positive impacts on the quality of life of those involved, many of the improvements occurred most prominently shortly after the move and the rate of improvement plateaued after a year.  This is a very similar finding to the earlier UK review and it was posited at the time that this may have been associated with a number of factors, including turnover of staff involved in the initial move.

The current review also found continuing low levels of community integration, which again was a feature of the earlier findings. They also found evidence that healthcare needs were not adequately met in community settings, which accords with much of the literature and recent enquiries into responses to healthcare in the UK.

The authors recommend that future research should include looking at the impact of quality of life outcomes of the level of learning disability and age of participants in the studies.

Deinstitutionalization and Quality of Life of Individuals With Intellectual Disability: A Review of the International Literature, Chowdhury, M. & Benson, B. , in Journal of Policy and Practice in Intellectual Disabilities, 8: 256–265

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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