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It is unclear how much the profound changes which have occurred in mental handicap hospitals in the last decade have improved the lot of the profoundly handicapped, since Baker &amp; Urquhart (1987), in a national survey of Scottish Mental Handicap Hospitals, found that 45% of all hospital residents had no set occupation and that there was a relationship between occupation and ability level. Between 14% and 32% of all patients were without occupation and unable, or not allowed, to leave the ward without a member of staff.

The quality of life of severely mentally handicapped patients in hospital