Abstract
Despite considerable agreement amongst psychiatrists that family relations play a critical role in the post-hospital adjustment of the mentally ill, there is disagreement as to how this operates. Combining clinical and social study methods, a study of this interaction was conducted following the method of Freeman-Simmons in Boston and Brown et al in London. One hundred and twenty-two mental hospital patients, male and female schizophrenics, discharged to families, were followed from the time of leaving hospital for one year. All patients were interviewed in the hospital. Patients were seen with their relatives at home shortly after, and direct ratings of the interaction then made. Subsequently, relatives were re-interviewed, in almost all cases, at the end of the follow-up year. The interaction data consists of: 1) direct observations; 2) attitude of the key relatives regarding their expectations for the patient; 3) systematic description of self and other collected for both the patients and the relatives; and 4) the interviewer's descriptions of the home context, including other family members. Predictive factors of one-year community tenure (expressed emotion of the relative, previous disability, clinical state at discharge) do not hold up for a Canadian population of mixed sex. The over-all rate of hospital return was low for this group, and as many from high risk subgroups returned as from more favoured groups. Particularly difficult to interpret is the finding that patients return to treatment at a constant rate each month. Re-hospitalization follows an acute flare-up, and is a rapid process when once suggested.
In general, the results support the Freeman-Simmons interpretation that post-hospital social performance is closely related to the relatives' expectancy, but that symptomatic course and re-hospitalization are relatively independent of either the relatives' expectancy or the emotional climate in the family.