The changing role of the state psychiatric hospital

Health Affairs

Volumn 28, Issue 3, 2009, Pages 676-684

  Fisher, William H ^a   Geller, Jeffrey L ^a   Pandiani, John A ^b  

^a UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL   (United States)

^b Bristol Observatory   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HOSPITAL SERVICE; HUMAN; MENTAL HEALTH; MENTAL HEALTH CARE; MENTAL HOSPITAL; PATIENT CARE; PUBLIC HOSPITAL;

COMMITMENT OF MENTALLY ILL; COOPERATIVE BEHAVIOR; COST CONTROL; CROSS-SECTIONAL STUDIES; DANGEROUS BEHAVIOR; FORECASTING; HEALTH CARE REFORM; HEALTH FACILITY CLOSURE; HEALTH POLICY; HEALTH SERVICES NEEDS AND DEMAND; HOSPITALS, PSYCHIATRIC; HOSPITALS, STATE; HUMANS; LENGTH OF STAY; MENTAL DISORDERS; UNITED STATES;

EID: 66749163599     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.3.676     Document Type: Article

References (44)

1. See J.P. Morrissey, H.H. Goldman, and L. Klerman, The Enduring Asylum: Cycles of Institutional Reform at Worcester State Hospital (New York: Grune and Stratton, 1980);
2. R.G. Frank and S.A. Glied, Better but Not Well: Mental Health Policy in the United States since 1950 (Baltimore: Johns Hopkins University Press, 2006);
3. D. Mechanic, Mental Health and Social Policy, 5th ed. (Boston: Person Education, 2008);
4. and C.A. Keisler and A.E. Sibulkin, Mental Hospitalization: Myths and Facts about a National Crisis (Newbury Park, N.J.: Sage, 1987).
5. P.J. Carling et al., "A State Mental Health System with No State Hospital The Vermont Feasibility Study," Hospital and Community Psychiatry 38, no. 6 (1987): 617-624. (Pubitemid 17110093)
6. National Association of State Mental Health Program Directors Research Institute, "State Psychiatric Hospitals: 2006," State Profile Highlights no. 06-14, 21 November 2006, http://www.nri-inc.org/projects/ Profiles/highlight.htm (accessed 9 February 2009).
7. Frank and Glied, Better but Not Well.
8. An important conceptualization of this process is in L.L. Bachrach, "A Conceptual Approach to Deinstitutionalization," Hospital and Community Psychiatry 29, no. 9 (1978): 573-578.
9. See also A.B. Rothbard, E. Richman, and T.R. Hadley, "'Unbundling' of State Hospital Services in the Community: The Philadelphia State Hospital Story," Administration and Policy in Mortal Health 24, no. 5 (1997): 391-398.
10. An overview of the evolution of civil commitment law is available in P.S. Appelbaum, Almost a Revolution: Mental Health Law and the Limits of Change (New York: Oxford University Press, 1994).
11. For a comparative analysis of service creation and financing, see W. Gronfein, "Incentives and Intentions in Mental Health Policy: A Comparison of the Medicaid and Community Mental Health Programs," Journal of Health and Social Behavior 26, no. 3 (1985): 192-206;
12. and Mechanic, Mental Health and Social Policy.
13. Frank and Glied, Better but Not Well.
14. W.H. Fisher et al., "The Role of General Hospitals in the Privatization of Inpatient Treatment for Serious Mental Illness," Hospital and Community Psychiatry 43, no. 11 (1992): 1114-1119;
15. R.A. Dorwart and S. Epstein, Privatization of Mental Health Care: A Fragile Balance (Westport, Conn.: Auburn House, 1993);
16. and J.L. Geller, "Excluding Institutions for Mental Diseases from Federal Reimbursement for Services: Strategy or Tragedy?" Psychiatric Services 51, no. 11 (2000): 1397-1403.
17. W.H. Fisher et al., "Case Mix in the 'Downsizing' State Hospital," Psychiatric Services 47, no. 3 (1996): 255-262.
18. Frank and Glied, Better but Not Well, 55.
19. NASMHPD Research Institute, "Closing and Reorganizing State Psychiatric Hospitals: 2003," State Profile Highlights no. 04-13, March 2004, http://www.nri-inc.org/projects/Profiles/highlight.htm (accessed 9 February 2009). This observed reduction in state hospital funding likely does not reflect reductions in per patient funding Indeed, given the necessary infrastructure remaining even after significant patient reductions - record rooms, heating and lighting, and so forth - the per patient cost likely increased.
20. A detailed account of this process as it unfolded in one state is provided in C.C. Upshur et al., "Closing State Mental Hospitals in Massachusetts: Policy, Process, and Impact," International Journal of Law and Psychiatry 20, no. 2 (1997): 199-217
21. NASMHPD Research Institute, "State Psychiatric Hospitals: 2006."
22. NASMHPD Research Institute, "Closing and Reorganizing State Psychiatric Hospitals: 2003."
23. John F. Kennedy, Message from the President of the United States Relative to Mental Illness and Mental Retardation to the House of Representatives, 5 February 1963, reprinted in H.A. Foley and S.S. Sharfstein, Madness and Government: Who Cares for the Mentally Ill? (Washington: American Psychiatric Association Press, 1983), 163-177
24. See, for example, H.J. Steadman, J.J. Cocozza, and M.E. Melick, "Explaining the Increased Arrest Rate among Mental Patients: The Changing Clientele of State Hospitals," American Journal of Psychiatry 135, no. 7 (1978): 816-820;
25. and H.J. Steadman et al., "The Impact of State Mental Hospital Deinstitutionalization on U.S. Prison Populations, 1968-1978," Journal of Criminal Law and Criminology 75, no. 2 (1984): 474-490.
26. W.H. Fisher et al., "Patterns and Prevalence of Arrest in a Statewide Cohort of Mental Health Care Consumers," Psychiatric Services 57, no. 11 (2006): 1623-1628. (Pubitemid 44807042)
27. R. Rosenheck et al., "Bed Closures and Incarceration Rates among Users of Veterans Affairs Mental Health Services," Psychiatric Services 51, no. 10 (2000): 1282-1287.
28. J.L. Geller and E. Lister, "The Process of Criminal Commitment for Pretrial Psychiatric Examination: An Evaluation," American Journal of Psychiatry 135, no. 1 (1978): 53-60.
29. Data provided by the Northeast Mental Health Statistics Improvement Program.
30. P.S. Appelbaum, "Confining Sex Offenders: The Supreme Court Takes a Dangerous Path," Psychiatric Services 48, no.10 (1997): 1265-1267
31. NASMHPD, "Position Statement on Laws Providing for the Civil Commitment of Sexually Violent Criminal Offenders," adopted 9 September 1997, http://www.nasmhpd.org/general-files/position-statement/sexpred.htm (accessed 9 February 2009).
32. W.H. Fisher et al., "Long-Stay Patients in State Psychiatric Hospitals at the End of the Twentieth Century," Psychiatric Services 52, no. 8 (2001): 1051-1056. (Pubitemid 32757996)
33. D.I. Meyerhoff, R. Smith, and J. Schleifer, "Academic-State Hospital Collaboration for a Rehabilitative Model of Care," Psychiatric Services 59, no. 12 (2008): 1474-1475.
34. K.L. Appelbaum et al., "Are Pretrial Commitments for Forensic Evaluation Used to Control Nuisance Behavior?" Hospital and Community Psychiatry 43, no. 6 (1992): 603-607;
35. and K.L. Appelbaum and W.H. Fisher, "Judges' Assumptions about the Appropriateness of Civil and Forensic Commitment," Psychiatric Services 48, no. 5 (1997): 710-712.
36. NASMHPD Research Institute, "State Psychiatric Hospitals: 2006."
37. Geller, "Excluding Institutions for Mental Diseases from Federal Reimbursement."
38. NASMHPD Research Institute, "State Psychiatric Hospitals: 2003."
39. See discussions in Dorwart and Epstein, Privatization of Mental Health Care;
40. and Fisher et al., "The Role of General Hospitals."
41. Fisher et al., "Long-Stay Patients";
42. and Meyerhoff et al., "Academic-State Hospital Collaboration."
43. J.L. Geller et al., "The Rights of State Hospital Patients: From State Hospitals to Their Alternatives," Administration and Policy in Mental Health 25, no. 4 (1998): 387-401. (Pubitemid 28355170)
44. A. Deutsch, The Shame of the States (New York: Harcourt Brace, 1948).