Second-generation deinstitutionalization. II: The impact of Brewster V. Dukakis on correlates of community and hospital utilization

Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655.
American Journal of Psychiatry (Impact Factor: 12.3). 09/1990; 147(8):988-93.
Source: PubMed


On the basis of the principle that patients have the right to be treated in the least restrictive setting appropriate to their needs, all 368 patients at Northampton State Hospital (Massachusetts) were discharged over a 10-year period. Three-quarters were discharged to community settings. Half of the patients were never rehospitalized, but many others continued to display patterns of recidivism. On the assumption that socially dysfunctional behavior would improve after discharge, the funded community system emphasized assessments, residential placements, and crisis intervention and deemphasized treatment. The findings raise many questions about the efficacy and wisdom of attempting to serve an entire state hospital population in the community.

6 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: In Turkey, the number of studies related to the problems, the functional levels, and last psychiatric status of discharged patients from a psychiatric unit is few. The aim of this study was to assess the levels of functional and psychiatric symptoms. Methods: Between the years 2000-2007, there were 816 patients who live in Sivas and who were discharged from Cumhuriyet University Hospital Psychiatric Clinic according to hospital registrations. Data were collected on 343 subjects by interviewing with their homes. The Personal and Disease Characteristic Information Form, Specific Level of Functioning Scale, and the Brief Symptom Inventory were used as the tools of data collection. The Student's t test, ANOVA, Pearson's correlation analysis was used in statistical analysis of data. Results: While 38.8% of the patients were continuing their treatments and their relationship with the institution, 17.5% had stopped their treatment based on the doctor's decision. In general, the level of func-
  • Source
    BMJ Clinical Research 04/1991; 302(6777):603-4. DOI:10.1136/bmj.302.6777.603 · 14.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Donna Kemp presents interesting information about the history and operation of the California mental health system in the preceding article, but the central thesis that the state's problems reflect conflict between dejure and defacto policy is an oversimplification. California's public mental health system has had inordinate demands placed upon it and is seriously underfunded. These problems are neither unique to California, ~ nor are they caused by defacto policymakers who are directing the system away from the goals envisioned by presumably better intentioned dejure policy-makers. Kemp's conception of what de jure policy is (or should be) is suggested by the claim that"California has never funded a total community mental health system which would serve the mentally ill in the least restrictive environment." This rhetoric is reminiscent of unrealistic claims made by proponents of community mental health centers in the 1960s that the new programs would eliminate the need for state hospitals and restore all seriously mentally ill patients to the community. 2 The inadequacies of public mental health programs are not just a matter of poor funding; they reflect the fact that the illnesses of the patients are often disabling and unresponsive to existing treatment methods. Even well-financed comprehensive community mental health programs cannot adequately serve significant numbers of severely mentally ill people who continue to require the services of state hospitals. Newer atypical antipsychotic medications may be able to improve the quality of life and reduce dependence on the state hospital of some of these patients who are refractory to conventional treatments, 4 but Clozapine, the only such medication in use in the United States, is inaccessible to most patients who might benefit from it? The author equates community care with outpatient care, apparently failing to recognize that inpatient treatment is an essential component of community mental health systems. California's innovative and successful Psychiatric Health Facilities (PHF) program, a model emulated by other states, is dismissed as contrary to dejure policy. The PHFs are lumped together with "inpatient care in state hospitals and ... acute care in general hospitals" as programs that, in effect, rob needed funds from "overburdened community treatment services." The inference that a funding shift from inpatient to outpatient programs would rectify this putative imbalance ignores the complex dynamics of deinstitutionalization. Deinstitutionalization is not a simple movement of people from one place to another, nor can it be accomplished by merely shifting funds from the budgets of hospitals to those of community programs. 6.7 What the author labels as "incremental decision making" seem s to be the California Legislature's way of targeting limited state dollars to neglected priority populations such as the seriously mentally ill and
    The Journal of Mental Health Administration 06/1991; 18(2):165-166. DOI:10.1007/BF02518611
Show more