***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : With the psychiatric deinstitutionalization movement in its fourth decade , questions are being raised concerning its relevance for long-stay in patients with severe disabilities and the risk that those discharged into the community may be ab and oned . Methods A r and om sample taken in 1989 of long-stay in patients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients . Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized . Pairs were matched for sex , age , length of stay , and level of psychiatric care in 1989 . Patients and staff were interviewed using st and ardized question naires , and case notes were review ed to assess symptoms , daily living skills , residential status , quality of residential setting , and clinical and social problems and needs . Results The investigation revealed that discharged patients moved to highly supervised setting s , which included professionally supervised group homes , supervised hostels , and foster families . About 20 % went to nursing homes owing to loss of autonomy from physical disorders . Only 4 discharged patients were lost to follow-up , of whom 2 were probable vagrants . Both those discharged and those remaining as in patients presented with major clinical problems and daily living skill deficits . The care needs of discharged patients were generally met , and placement in the community was considered appropriate . Of those who had remained hospitalized , over one-half could be moved to supervised setting s immediately , or after 1 to 2 years ' preparation in a discharge unit , while 13 % could be moved to nursing homes . Over 25 % required intensive , individualized rehabilitation treatment targeting engagement , psychotic symptoms , withdrawal , and dangerous and socially embarrassing behaviours . Conclusion Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient ab and onment in the community Background Homelessness and mental illness have a strong association with public disorder and criminality . Experimental evidence indicates that Housing First ( HF ) increases housing stability and perceived choice among those experiencing chronic homelessness and mental disorders . HF is also associated with lower residential costs than common alternative approaches . Few studies have examined the effect of HF on criminal behavior . Methods Individuals meeting criteria for homelessness and a current mental disorder were r and omized to one of three conditions treatment as usual ( reference ) ; scattered site HF ; and congregate HF .  Administrative data concerning justice system events were linked in order to study prior histories of offending and to test the relationship between housing status and offending following r and omization for up to two years . Results The majority of the sample ( 67 % ) was involved with the justice system , with a mean of 8.07 convictions per person in the ten years prior to recruitment . The most common category of crime was “ property offences ” ( mean = 4.09 ) . Following r and omization , the scattered site HF condition was associated with significantly lower numbers of sentences than treatment as usual ( Adjusted IRR = 0.29 ; 95 % CI 0.12–0.72 ) . Congregate HF was associated with a marginally significant reduction in sentences compared to treatment as usual ( Adjusted IRR = 0.55 ; 95 % CI : 0.26–1.14 ) . Conclusions This study is the first r and omized controlled trial to demonstrate benefits of HF among a homeless sample with mental illness in the domain of public safety and crime . Our sample was frequently involved with the justice system , with great personal and societal costs . Further implementation of HF is strongly indicated , particularly in the scattered site format . Research examining interdependencies between housing , health , and the justice system is indicated . Trial registration IS RCT OBJECTIVE In Upper Austria , a total of 409 long-stay patients were discharged to various residential facilities between 1995 and 2000 . This paper describes psychopathology and sociodemographic characteristics . METHODS A r and om sample of 116 former long-stay patients were followed for an average 42.9 months after discharge . RESULTS Patients had spent an average 19.3 years in psychiatric wards . 47 patients ( 40.5 % ) were placed in nursing homes , 16 patients ( 13.8 % ) in old-age homes , 32 patients ( 27.6 % ) in other institutions and only 15 patients ( 12.9 % ) in group homes , and 6 patients ( 5.2 % ) with families . ICD-10 diagnosis was schizophrenia in 56 patients ( 48.3 % ) and mental retardation in 33 patients ( 28.4 % ) . Level of social and functional disabilities was high . CONCLUSIONS Most long-stay patients were able to live outside psychiatric hospitals , but institutional care still plays an essential role 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 prospect i ve repeated- measures design . Skills and behavioural problems were assessed by keyworkers . Self-perceived quality of life was obtained during interviews with research ers 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 < or = 0.01 ) 12 months after discharge ( N = 119 ) and were more satisfied ( P < or = 0.05 ) with their new ' homes ' ( n = 108 ) . There were few changes in the pattern of 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 Irel and 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 This paper review s briefly the history of mental health de population in Canada over the past 30 years . The term “ deinstitutionalization ” is often used but is unsatisfactory . Using an exploratory , qualitative , method ological approach , data were collected on the problems encountered by a disproportionate , stratified r and om sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada . Adopting a symbolic interactionist theoretical approach , this study , in an effort to fill a neglect in the literature , attempted to discover what the everyday world(s ) of Canadian ex-mental patients was really like . Problems encountered related to stigma , poor housing , lack of back living skills , poverty , unemployment and aftercare . Quotations from patients are provided to illustrate such themes . The findings are discussed OBJECTIVES The purpose of this study was to evaluate effects associated with moving patients from hospital to community-based setting s , to compare persons who left the hospital with those who remained in the hospital , and to address the question of whether discharge reverses institutionalism in a sample of elderly long-stay psychiatric in patients . METHODS The hypotheses were that , compared with the control group of patients who stayed in the hospital , those who left would have significantly better mental states , social functioning , and social networks at follow-up ; that community setting s would provide a significantly better quality of environment than the hospital ; and that discharged patients would express a preference for community care after discharge from the hospital . The study was a prospect i ve nonr and omized controlled trial at Cane Hill , Friern , and Claybury Hospitals in Engl and . Sixty long-term patients with schizophrenia who were discharged to community care were compared over time with matched controls ( N=131 ) . RESULTS No overall differences were detected in the pattern or severity of symptoms between patients who were discharged from the hospital and those who were not , and no significant changes over time were noted . Significant improvements in social networks , patients ' preference for community setting s , and quality of clinical environment were noted . CONCLUSIONS These results give qualified support for moving long-stay psychiatric patients from hospital to community setting BACKGROUND The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and st and ard treatment has not previously been investigated in first-episode psychosis . The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing . METHOD A total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and r and omized to either the specialized assertive intervention program ( OPUS ) , st and ard treatment or hospital-based rehabilitation .  RESULTS It was a stable pattern that patients r and omized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups . Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation . Due to attrition and small sample size , differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated . CONCLUSIONS The study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing . The data can not justify using hospital-based rehabilitation in first-episode psychosis Background : This study examines the psychosocial outcomes of women discharged from the Vlore Psychiatric Hospital in Albania . Methods : The study was design ed as a controlled , not r and omized , follow-up study . It included 16 women diagnosed with psychosis who were discharged from a psychiatric hospital to live in group homes in the community . The control group included 20 women diagnosed with psychosis who lived at the psychiatric hospital while awaiting discharge . All subjects were assessed twice using the  HoNOS-Rome tool  , at the start of the study ( T0 ) and 12 months later ( T1 ) . Results : Both groups showed an improvement in the HoNOS total score between T0 and T1 ( p < .001 ) . This improvement was significantly larger in the Home group compared to the Hospital group ( p = .014 ) . An item-level analysis indicated a significantly greater improvement in the Home group on items 11 ( autonomy ) , 12 ( work ) , 16 ( family ) and 18 ( goals ) . Conclusions : Projects for social inclusion of people suffering from psychosis must design living spaces that offer viable alternatives to psychiatric hospitals . This study also documents the efforts in the Vlore region of Albania to follow European st and ards of mental health care 
    Output:
    
Our results contradict the findings of ecological studies which indicated a strong correlation between the decreasing number of psychiatric beds and an increasing number of people with mental health problems who were homeless or in prison