Who will treat psychiatrically disturbed developmentally disabled patients? A health care nightmare

The authors assess the impact of a policy adopted briefly in New York State to facilitate short-term hospitalization and long-term aftercare of psychiatrically disturbed, developmentally disabled patients. Denied admission to New York State facilities that provide long-term care for the psychiatrically disturbed or the developmentally disabled, these dually diagnosed patients have often languished in the emergency room of municipal hospitals or been inappropriately hospitalized in the acute-care psychiatric unit, sometimes for several months. The authors conclude that the policy expedited hospitalization but failed to facilitate patients' discharge because it did not address the underlying need for suitable aftercare facilities. Overlapping clinical and administrative issues and political exigencies that complicated the policymaking process are discussed.