Charge to the Community: Some Early Effects of a State Hospital System's Change of Policy

The carrott and the stick: Inducing local programs to serve long-term patients

“…All things being equal, long-term patients find themselves at the bottom of the list of community mental health priorities unless there is some incentive or motivating force to change this. Even in states like New York (Robbins & Robbins, 1974) where the state discharged thousands of mental patients without prior development of resources in order to galvanize local communities into action, the resulting increase in community services has been disappointing. California chose not only to engage in the wholesale discharge of patients from state hospitals but also to provide a number of inducements and to propose a number of penalties to local programs to induce them to serve long-term patients.…”

“…So long as the state hospital remains an easily accessible resource, community mental health centers usually are slow to develop community alternatives for long-term patients; but simply closing the hospitals and placing the patients in the community does not automatically result in a mushrooming of services for chronic schizophrenics (Robbins & Robbins, 1974). Our society seems fully as capable of neglecting them in the community as it did on the back wards of state hospitals.…”

Planning the phasedown of mental hospitals

“…The apprehensions that were expressed centered around job security for personnel and the insuring of human services for state hospital dischargees. Thus the issue no longer is whether to phase down institutional services rapidly but rather how to accomplish this goal in tandem with the expansion of community alternatives so that patients benefit rather than suffer during the critical transitional period (Robbins & Robbins, 1974).…”