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PubMed1980

From hospitals to jails: the fate of California's deinstitutionalized mentally ill.

This paper describes a shift of mentally ill persons from custodial care in state institutions during the 1960s to prosecution in criminal courts during the 1970s. The shift is attributed to the unforeseen clinical needs of this new outpatient population, the inability of community mental health centers to meet these needs, and the changes in mental health laws, specifically their emphasis on the concept of dangerousness.

California↗
PubMed1983

Mortality in the era of deinstitutionalization.

The authors examined the 3 1/2-year mortality rate of 1,033 psychiatric patients who had received inpatient treatment during a 1-year period, using standardized mortality ratios to identify heightened risk. Deaths due to accidents or suicides and pneumonia occurred more frequently than expected. Deaths due to cancer occurred primarily among alcoholics; nonalcoholic patients had a significantly lower cancer mortality risk. The risk associated with age was greatest for young patients in general, but male schizophrenic patients and female alcoholics died at particularly young ages. The highest mortality risk associated with diagnosis was for male patients with affective disorders. The authors discuss the implications of these findings.

Accidents↗
PubMed1986

Elderly schizophrenic inpatients in the wake of deinstitutionalization.

The authors investigated the factors relating to the observation that in a large state hospital, there is an age-related increase in the ratio of patients with a DSM-II diagnosis of paranoid schizophrenia to those with a diagnosis of nonparanoid schizophrenia. Elderly inpatients (N = 1,518) treated over a 5-year period were studied and the hypotheses of proportionately greater numbers with late onset of paranoid conditions, longer lengths of stay for recently admitted paranoid patients, and changing diagnosis over time were tested and rejected. The data suggest that the buildup among the elderly of those diagnosed under DSM-II to have paranoid conditions is due to patients admitted well before age 54. The authors discuss the reasons for the poor prognosis of this group.

Age Factors↗
PubMed1990

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

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.

Adult↗
PubMed2006

State psychiatric hospital census after the 1999 Olmstead Decision: evidence of decelerating deinstitutionalization.

OBJECTIVE: The Supreme Court ruled in the 1999 Olmstead decision that "unjustified isolation" of individuals with disabilities in institutions is a violation of the Americans With Disabilities Act. This study examined the extent to which state psychiatric hospital census across the United States has changed significantly post-Olmstead. METHODS: Twenty years of national state hospital census data (1984-2003) were used to assess trends in the rate of declines from pre- to post-Olmstead periods. Data were organized into five four-year periods. RESULTS: Steady declines in the hospital census nationally were found over all periods, with especially large decreases in the 1990s. However, when the percent change in hospital census in the two periods immediately before the Olmstead decision (between 1992-1995 and 1996-1999) were compared with the percent change in the periods immediately before and immediately after the Olmstead decision (between 1996-1999 and 2000-2003), an 8 percent decrease in the magnitude of decline was seen. CONCLUSIONS: 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.

Censuses↗