The development of appropriate community care requires knowledge of the characteristics of the severely mentally ill.

All patients with a broad diagnosis of schizophrenia (n=528) were identified via key informants within an inner London health district; Feighner and DSM–III–R criteria for schizophrenia were applied. Clinical and social status, psychopathology (Manchester Scale) and problem behaviours (Social Behaviour Schedule) were assessed in a 4:5 representative sample.

Fifty-seven per cent had experienced at least one compulsory admission. Forty-five per cent (excluding long-stay in-patients) had marked positive psychotic symptoms; social isolation and lack of daytime activity was more common than among comparable populations elsewhere. One hundred and eleven (25%) of the non-hospitalised patients were not in contact with specialist services.

Difficulties in establishing and maintaining a therapeutic alliance between patients and professionals present a challenge to services in inner London. Many social and occupational needs were not being met by existing community provision.