Phasing out state hospitals -- a psychiatric dilemma

Area of Science:

• Psychiatry
• Public Health Policy

Background:

• The role of state hospitals in mental healthcare has been debated for years.
• Inpatient census in public mental hospitals has significantly decreased due to effective treatments.

Purpose of the Study:

• To analyze the feasibility of phasing out state hospitals for mental healthcare.
• To examine the impact of deinstitutionalization programs and community service availability.

Main Methods:

• Analysis of inpatient census trends in public mental hospitals.
• Review of the effectiveness of psychiatric treatment programs.
• Assessment of the development and availability of community-based psychiatric services and residential alternatives.

Main Results:

• Inpatient census dropped from 490,000 to 215,000 due to improved treatment programs.
• Most state hospital patients could be treated in the community with adequate services.
• Failure to establish community services has discredited deinstitutionalization and halted state hospital phase-out plans.

Conclusions:

• Phasing out state hospitals is clinically possible but currently unlikely.
• Lack of fiscal and ideological commitment to community-based treatment is a major barrier.
• Comprehensive community psychiatric services are essential for successful deinstitutionalization.