Referral patterns to and from inpatient psychiatric services: a social network approach

Interorganizational linkages have assumed more import for mental health service systems during the past three decades because of increased levels of complexity in service delivery patterns. This analysis examines these linkages from a relational perspective, with network of patient referral patterns as the basic unit. Multidimensional scaling is employed to discern patterns of interorganizational linkages in national patient referral data collected by the National Institute of Mental Health in 1975 and 1980 for patient samples from inpatient psychiatric services of state and county mental hospitals, private psychiatric hospitals, and public and nonpublic general hospitals. The multidimensional scaling techniques distinguish two structural characteristics of the interorganizational linkages of psychiatric inpatient services--public vs private services, and drift over time in referral patterns. Public and private inpatient psychiatric services are differentiated principally in terms of degree of interaction with legal agencies and private practice psychiatrists. Chronological change in referral patterns is characterized principally by changes in the degree of interaction with other inpatient or outpatient psychiatric services. Methodologically and theoretically, the techniques and findings described can enhance our understanding of interorganizational linkages and dynamics.