Serving the chronic mentally ill in state and community hospitals

Acute psychiatric admissions to three state and three community hospitals from the same geographic areas were examined in terms of patient characteristics, services, and costs. Overall, patients in state hospitals were more likely than patients in community hospitals to be admitted involuntarily, to have bizarre or assaultive behaviors as a precipitating cause of admission, to have recent community mental health involvement, to be referred by family or friends, to be living in dependent care at admission, and to have police initiated admissions; differences on other variables such as prior psychiatric hospitalizations, or in-hospital behaviors were not significant. The length of stay was longer for state hospital patients who were also more likely to be discharged to an independent living situation. While actual costs per inpatient day were greater for community hospitals, the costs of treating patients in state hospitals, after reimbursements, were greater on both an inpatient day and episode basis. The average savings per inpatient day of treating all patients in community hospitals versus the hospitals they were in at the time of the study would be $7.38 per day. The conservative average cost savings per episode would be $440. This data suggests that it may be less expensive to the state to treat patients in community hospitals.