Phasing out State Hospitals — A Psychiatric Dilemma

Abstract

Whether state hospitals have a role in caring for mentally ill persons has been intensely debated for the past decade. During this time the inpatient census of public mental hospitals has fallen dramatically from 490,000 to 215,000 owing to increasingly effective treatment programs for acutely and chronically psychotic patients. The vast majority of patients currently cared for in state hospitals could be adequately treated in the community if a comprehensive spectrum of psychiatric services and residential alternatives were established. The failure to establish this network of community services before the discharge of thousands of patients has discredited the deinstitutionalization programs in many states, including California and New York, and forced California to abandon its plan to phase out all its state hospitals. Thus, although phase out of state hospitals is clinically feasible, it is unlikely at present since the fiscal and ideologic commitment to shift to community-based treatment is lacking.

Community Mental Health Centres1: An American Response to Kathleen Jones

“…Many authors (Chu 1974, Lorber & Satow 1975, Becker & Schulberg 1976) have supported our own research findings that the professional staff at CMHCs favour the treatment of young, mildly disturbed patients. At our regional centre, these latter patients were primarily distributed to the psychotherapy unit for treatment.…”

“…Initially, CMHCs were charged with the task of eliminating the abysmal public hospital system (i.e. State hospitals) (Becker & Schulberg 1976). Prior to 1960 and the beginning of the CMHC movement, these state-run facilities dominated American psychiatry (both public and private) and were the only source of public psychiatric treatment.…”

MUTUAL WITHDRAWAL… or GWEN TUDOR Revisited

“…The psychiatric literature suggests that services were neither available nor coordinated. (Becker and Schulberg, 1976;Kirk and Therrein, 1975) At best, we cannot compute the cost of community care, and at worst, it is more expensive. (Bassuk and Gerson, 1978;Reider, 1974) Deinstitutionalization has removed patients from the isolation of the back wards only to further isolate them in the community.…”

L’état des hôpitaux psychiatriques publics aux États-Unis en 1996

“…Premièrement, les gestionnaires et les fournisseurs de services doivent reconnaître que malgré l'existence de modèles pour certains systèmes de soins dans des communautés américaines, la croissance des services communautaires dans ce pays est loin d'avoir réussi à éliminer le besoin de l'hôpital psychiatrique public. La question, si on lit bien entre les lignes de la littérature, n'est pas tant de savoir si la communauté a le potentiel voulu pour fournir un éventail de services (Becker et Schulberg, 1976;Okin, 1995), mais plutôt si elle possède les ressources et la volonté de le faire. Ces ingrédients critiques absents, les soins en hôpital psychiatrique public doivent encore être vus comme un élément essentiel dans n'importe quel continuum de services.…”