State Psychiatric Hospital Census After the 1999 Olmstead Decision: Evidence of Decelerating Deinstitutionalization

Abstract

State hospital census continues to decline but has slowed significantly during the post-Olmstead period. More study of the factors associated with this decline is needed.

Premature Mortality Among Patients Recently Discharged From Their First Inpatient Psychiatric Treatment

“…ental disorders are associated with an elevated risk of premature mortality. [1][2][3] The inpatient psychiatric capacity in Western countries has been shrinking for several decades, [4][5][6][7] shifting mental health treatment to community and other institutional settings. 8 Consequently, patients with psychiatric care needs are, generally, the most severely ill and have a markedly elevated risk of dying prematurely.…”

Recovery-Oriented Training and Staff Attitudes over Time in Two State Hospitals

“…Unfortunately, as the recovery movement was mostly borne out of an era that began to shun state hospitals, efforts to transform systems of care to be more recovery-oriented have focused on community mental health providers (2). However, public psychiatric hospitals are still in every state serving over 150,000 people with mental illness annually (3). State hospitals are still very much in use and represent an important part of the continuum of care (4,5).…”

Anti-depressants and Suicide

“…But there is a long history of concern that the deinstitutionalization process may have led to a higher suicide rate [e.g. Hansen et al, 2001;Flechner, Wolf and Priebe, 1995;Salzer et al, 2006] Kahneman and Tversky [1979] call "editing" and ignore these risks altogether [see also Kunreuther, 1978]. Another "lulling effect" might stem from the fact that some self-injury attempts may be motivated by reasons other than the desire to end life, including to signal for help, punish family or friends, or secure resources more generally [Rosenthal, 1993;Cutler, Glaeser and Norberg, 2001;Marcotte, 2003].…”