The determinants of average daily census in public mental hospitals: a simultaneous model

Increasing effort and resources are being devoted to reducing the reliance on state institutions for the mentally ill. Little empirical support is available for many of the proposed policies. In this article we construct and estimate a model based on the assertion that rates of institutionalization in public mental hospitals are dependent upon the availability of alternative treatment facilities, the legal environment, the prevalence of mental illness and the cost of care. A two-equation model is estimated using pooled cross-sectional state data for 1974 and 1975. The results show a significant correlation between rates of public mental hospital average daily census and expenditures per patient day, certain aspects of commitment statutes and the presence of Community Mental Health Center and alcoholic halfway-house beds.