1. A comparison of the profiles of people discharged from Russell Clinic in the periods from October 2002 to October 2004, October 2004 to October 2006 and October 2006 to December 2008 This study is a result of the joint efforts of Mel Long, Glenn Roberts and John Good

2. Service Evaluation Methodology This is a retrospective review of activity relating to people discharged over the three periods thereby allowing comparisons to be made over time. It is intended that this study will aid discussions about the development of the service.

3. Cohorts Cohort one Consists of 19 people discharged from the service in the period from October 2002 to October 2004. Of these 1 person had 2 admissions to Russell Clinic. Cohort two Consists of 17 people discharged from the service in the period from October 2004 to October 2006. Of these 1 person had 2 admissions to Russell Clinic. Cohort three Consists of 26 people discharged from the service in the period from October 2006 to December 2008.

4. % of People Admitted From the Three Geographical Areas of the Trust

5. Where were people admitted from? (%)

6. Average length of stay in previous service prior to admission to RC

7. Length of stay in Russell Clinic

8. Where were people discharged to? (%)

9. Gender (%)

10. Average Age

11. Average duration of psychiatric history prior to admission (months)

12. Average number of volumes of notes

13. Mental Health Act status

14. Percentage of people who remained on a section for the duration of their stay

15. Average length of time between admission and becoming informal

16. How many admissions to hospital did people have during the eighteen month follow up period (%)

17. Percentage reduction in the amount of time spent in hospital and the number of admissions following a stay in RC

18. Conclusions People who come to Russell Clinic are on average in their 30s and this has changed very little over the six year period Russell Clinic has increased its through put with 19 people being discharged in cohort one to 26 in cohort three The length of stay has steadily declined in spite of the fact that increasing numbers of people have come from IPP or forensic settings The client group has remained a relatively young group of people with severe, recurrent and complex mental health problems although the length of history has decreased significantly from an average of 167 months for cohort one to 121 months for cohort two and 100 months for cohort three. There has been a significant increase in people admitted from North Devon over the six year period but no increase in people admitted from South Devon. South Devon have, however, only been accepted since summer 2007.

19. Conclusions All have a diagnosis of psychosis and the majority schizophrenia. Nearly all come from other hospital environments where they had lengthy periods of treatment – some very lengthy – particularly if out of area (IPP) or from Forensic services. This average period of time has increased over the years but this is unsurprising given the increase in admissions from IPP and forensic settings. Although the period of time spent in the previous service has increased over time the length of history has reduced as has the number of volumes of notes. This indicates that while people admitted to Russell Clinic continue to have complex problems they are reaching RC sooner. There has been an increase in informal admissions over the six year period, but also an increase in those admitted under section 37/41

20. Conclusions The main reasons for referral are that people have become stuck where they are, have considerable difficulty with self care and self management and have burned their bridges in other environments such that they cannot be safely discharged. There has been a decrease over time of the proportion of people being discharged to residential care and an increase in those discharged to supported living. This probably reflects a change in service provision and aspiration. There has also been a decline in those discharged to their own or a family home perhaps reflecting the alienation from their previous community caused by placement in IPP or forensic settings. Another factor could be the services increasing emphasis on promoting individuals wish for independence by not automatically returning to the parental home. There has been an increase in those returned to IPP, forensic or acute settings over the years probably reflecting the increased risk profile and complexity of those admitted. The gender mix does not change significantly over the six year period There is a significant decrease in time spent in hospital and the number of admissions people had after a period of time spent on RC.