ABSTRACT
The appraisal of a psychiatric service involves comparison of the service to be evaluated with the measured outcome of an evaluated alternative. In the London and Buckinghamshire surveys performance and outcome of the institutional psychiatric service are evaluated entirely in terms of socio-demographic features of the general population, of the population admitted to hospital and the statistics of hospital events. A further refinement of the method used in the comparison of hospitals was the demonstration of associations between specific items of hospital environmental poverty and particular features of institutionalism in patients. Assessments of social withdrawal, socially embarrassing behaviour, and patient attitude to discharge were made as had been done for the British hospital cohort, giving a measure of ‘institutionalism’. Although the studies in the evaluation of institutional psychiatry examined demonstrate the practical feasibility of the principle, application has been dilatory and little progress has been made.
