2.2.3 Improper placement of a long-time patient in a psychiatric facility has been ended On the occasion of a site visit, Commission 1 found that in the Hall Regional Hospital several persons were being cared for primarily as inpatients because, despite efforts by the hospital, no suitable facilities for external after-care could be found. Insufficient care facilities For example, a patient has been under psychiatric care as an inpatient for around 20 years with only a few release periods. His medical condition is characterised by both calm phases and seizure-like impulse outbursts accompanied by dysphoria and aggressive behaviour toward both objects and people. An outpatient facility would only be suitable for his after-care if it is ensured that it has sufficient staff with appropriate qualifications in psychiatric care. However, the search for such a suitable facility for this patient has been extremely difficult. He was in a residential home for some time but it was unclear whether Tyrol would provide the necessary funds for his care in this facility in order to guarantee adequate care. In the course of an investigative proceeding, it was possible, however, to find a facility that offered to provide suitable housing and care for this patient outside a psychiatric facility. Care availability This case is an example that the existing system of care outside of a psychiatric ward or facility and allocation of patients is overwhelmed, especially in difficult cases. Structural problems In the course of the reform of the psychiatric system, a broad-based de-institutionalisation, differentiation and qualification of care of persons with chronic mental impairments has taken place, resulting in a significant improvement of the living conditions of affected persons and of the care they receive. It is necessary, however, to eliminate care deficits with regard to persons who alternate between active phases of their disorder and phases of more or less intact health and who continue to require psychiatric care and rehabilitation. It would be urgently necessary to provide more support throughout Austria with regard to residential facilities for persons with chronic mental disorders, particularly those diagnosed with schizophrenia with pronounced symptoms, co-morbid disorders or a forensic history and for people with psycho-mental developmental impairments who frequently display psychiatrically relevant episodes. Overall, it is about creating flexible framework conditions that enable those persons affected to live their lives as independently as possible. This includes work and occupational opportunities that have a positive effect on the disorder as well as on social integration and quality of life. 49