“Quality of life” (QOL) appears intrinsically important but difficult to measure. As a mental health professional, one might wish to know whether patients moving from the security of hospital to “the community” improve their QOL, or to evaluate their QOL against that of other groups in society. Simply looking at symptom change or economic cost-benefit misses much of the point behind innovations in psychiatric services. From previous QOL assessments (e.g. Lehman, 1983) one would focus upon positive aspects such as living situation, personal relationships, and general health and on negative aspects such as lack of money or being a victim of crime. Literature from the 1950s and 60s attests to the adverse effects of institutional care but more recently writers such as Kathleen Jones (Jones et al, 1986) have drawn attention to the benefits of living in such an environment. Also, various well-publicised “scandals” have suggested the pitfalls of inadequately thought-out discharge into the community.
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