Beds in Israel's private psychiatric hospitals, where the standard of care is markedly lower than in state-run facilities, are being closed down. Their patients - many hospitalized for years - are being re-assessed and those still needing inpatient care transferred to state hospitals. The aim is to give a better quality of life, conduct a thorough psychiatric reappraisal and offer the latest therapeutic options.

The merged Be'er Ya'akov-Ness Ziona- Israel Prisons Service Mental Health Center set up a multidisciplinary team to conduct a coordinated process of reappraisal, preparation, reorganization and admission for these patients and their families. We found in the patients complex self-management problems, a high level of dependency, severe neglect, a range of tendencies to violence, and mistrust of the staff. The family members revealed high levels of anxiety and fear. Given this situation, a nursing staffer was appointed to liaise with the families, be freely available for consultation and act as patient advocate.

In this presentation we describe the core principles for this multidisciplinary reassessment and re-placement process, which began by assessing the patients in their setting of origin. We report on the planning of new interventions incorporating the latest therapeutic advances, exceptional incidents, changing the profile of the psychogeriatric ward, etc. We offer the conclusions and recommendations drawn from this change process, undergone equally by patients, family members and staff, and report on its results, which for many of the patients led to a more open care-setting in the community and for some a return home.