The community and deinstitutionalization: a model for working with municipalities.
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This is a case study of ninety-two patients served by an outpatient service of a state psychiatric hospital in a rural area in west central New York State. The purpose was to identify variables associated with success (tenure in the community) and lack of success (number of readmissions within last year and five years and one subsequent year). Using a stepwise multiple regression analysis, age and living with others were positively correlated with success and negatively correlated with rehospitalizations within one year. Over a five-year period, affective disorders, inconsistency in taking medication, and having a hobby were correlated with multiple hospitalizations. In the year following data collection, readmissions were related only to inconsistency in taking medication. Mental health practitioners are advised to carefully follow up persons at highest risk of returning to the hospital.
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This article examines the extent to which the costs of formal health care are shifted from third-party payers to the patient and his or her family, especially during the transition to the community after discharge from a state hospital. Findings indicate that patients residing in the community are as likely to receive some care as their counterparts in institutions, but are at higher risk for uncovered care. Uncovered care is more likely to manifest as an unmet need for patients who have been recently discharged, especially for racial minorities, and as an out-of-pocket expense for patients who are established in the community.