State mental health institutions in the next decade: illusions and reality

Rejecting assertions that state mental health institutions are dying, the authors describe current proposals conceringin future roles of institutions and put forward two postulates as the basis for successful change. They argue that new or different roles for state mental health institution can better be developed if there exists a statewide structure that can both promote and direct change, and if there is a regionally based statewide plan for change that has the support of state, regional, and local leaders. They give several examples of institutionally based service units that could be operated in concert with community services in a unified mental health system. They urge mental health administrators to admit the need for institutional change and to provide active leadership in bringing it about.