Since the 1970s mental-health services have increasingly been delivered in the community. However, people with longer-term and more complex mental-health problems have sometimes been referred for Out of Area Treatments (OATs), something that has been called a 'virtual asylum.' OATs are very expensive (they cost £222m in 2004-5), can separate service users from their families and can cause disruption to communication about, and continuity of, care planning. A team of researchers from North London looked at 51 service users who were being treated on OATs in the North London borough of Islington. They found that they had a greater range of diagnoses and were more likely to be dependent on alcohol than other service users. Their social functioning was similar and although people in OATs had more severe 'challenging' behaviour few were defined as 'hard to place' in community settings. A third of the people on OATs moved successfully to a more independent setting and the money that Islington received for them was successfully reinvested into providing supported local accomodation. The service users had fairly low levels of contact with their friends and families (although it should be remembered that in some cases this might not necessarily be a bad thing) suggesting that they may have suffered from a certain amount of 'social dislocation.'
Killaspy, Helen ... [et al] - A comparison of service users placed out of their local area and local rehabilitation service users Journal of Mental Health April 2009, 18(2), 111-120