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At least 19 recordsLinked to original sources
PubMed1998

The rights of state hospital patients: from state hospitals to their alternatives.

During the 1980s and 1990s the locus of psychiatric treatment in many states shifted from state hospitals to the psychiatric units of general hospitals. The extent to which the rights guaranteed to psychiatric inpatients by state mental health agencies will survive this "privatization" process is unclear. The authors explore this issue by providing a "status report" of patient rights, identified through a national survey. They discuss the problems of preserving these rights as an ever greater proportion of care is provided in general hospitals under the mechanism of managed care.

Deinstitutionalization↗
PubMed1985

Psychiatric diagnosis in a state hospital: Manhattan state revisited.

Studies have documented the predeliction of New York hospitals to overdiagnose schizophrenia and to underdiagnose affective disorders. To further investigate that predeliction following the introduction of DSM-III diagnostic criteria, seven clinical experts at the Manhattan Psychiatric Center reevaluated the charts of 131 randomly selected patients and conducted clinical reviews of two subgroups of the sample. Rediagnosis essentially reversed the ratio of schizophrenia to affective disorder shown in the charts, indicated a lack of documented DSM-III criteria for the chart diagnoses, and revealed significant numbers of undiagnosed disorders. The diagnostic, prognostic, and treatment implications of the findings are discussed, especially the need for more precise differential diagnosis according to DSM-III criteria.

Affective Disorders, Psychotic↗
PubMed2003

Prevalence of hepatitis A, hepatitis B, and HIV among hepatitis C-seropositive state hospital patients: results from Oregon State Hospital.

BACKGROUND: Multiple studies have shown that individuals with severe mental illness are at increased risk for acquiring infection from human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Moreover, patients with chronic HCV infection are at risk for fulminant hepatitis from acquired infection with hepatitis A virus (HAV) or HBV, but there are limited data on the prevalence of HIV, HAV, and HBV in chronically hospitalized U.S. psychiatric patients without mental retardation who are HCV-seropositive. To address this issue, a comprehensive screening program was commenced at Oregon State Hospital (Salem, Ore.) beginning in 1999. METHOD: The computerized records of all non-geriatric adult inpatients at Oregon State Hospital on April 23, 2001, were reviewed to assess physician compliance with screening and the prevalence of infection with HIV, HAV, HBV, and HCV. RESULTS: Among the 535 patient records reviewed, 94.8% of patients were screened for HCV, of whom 20.3% were seropositive. Among HCV-seropositive patients, only 1.9% were not screened for HAV and HBV, but 23.3% were not tested for HIV. In the HCV-seropositive group, 35.9% were HAV-positive, 49.5% HBV-positive, and 2.6% HIV-positive. CONCLUSION: Chronic psychiatric inpatients have high HCV prevalence rates. Hepatitis C-seropositive individuals may be at risk for complications unless vaccinated for HAV and HBV.

Adult↗
PubMed1997

"Unbundling" of state hospital services in the community: the Philadelphia State Hospital story.

This paper describes the organizational, financial, and programmatic changes surrounding the closure of Philadelphia State Hospital, and the conceptual model employed for "unbundling" or disaggregating the state hospital's services into community programs run by private non-profit agencies. The current status of the project is discussed as well as the long-term policy and research questions that remain to be answered.

Community Mental Health Services↗
PubMed1980

Transfers from a general hospital psychiatric service to a state hospital.

The authors investigated the marked decline in the number of patients transferred from an inpatient service of a general hospital to a state hospital during a 30-month period. The major reasons for transfer were unmanageable behavior, high risk of suicide or homicide, administrative considerations, and unremitting or deteriorating course. They found that administrative concern about three factors--the many problems of patients likely to be transferred, staff anxiety, and the relationship between the general hospital and state hospital units--can facilitate the decline in the number of patients transferred to a state hospital.

Adolescent↗
PubMed1983

The limits of general hospital care: a continuing role for state hospitals.

An examination of the characteristics of patients transferred to a state hospital after their treatment in a rural community general hospital had failed provides some data for defining the state hospital's role in relation to such patients. Of 2,128 discharges from the general hospital in a three-year period, 33, or 1.6 percent, were referred to the state hospital. The patients could be divided into four subgroups: violent patients, unresponsive patients with severely disorganized mental states, dependent patients treated successfully but referred because of a lack of community residential facilities, and deteriorating alcoholic recidivists who had proved to be unresponsive to treatment. At follow-up, the most improvements had occurred among the unresponsive subgroup. The author believes that, among those subgroups, state hospitals are most useful for violent patients, for deteriorating recidivist alcoholics, and, depending on further research, possibly for unresponsive patients.

Adult↗
PubMed1975

Minnesota: the impact of a community hospital's psychiatric unit on a regional state hospital.

A community hospital serving part of a state hospital's receiving area opened a psychiatric inpatient unit. The authors studied the impact of the new unit on the number of psychiatric admissions to the state hospital, and also sought to determine if the two facilities provided duplicate services to the area. In comparing admission rates to the state hospital before and after the opening of the community unit, they found the unit did not have a significant impact. In comparing sample groups of patients at the two hospitals, they found that each served a different socioeconomic group and therefore did not offer duplicate services.

Hospitals, Community↗
PubMed1996

The evolving role of the state hospital in the care and treatment of older adults: state trend, 1984 to 1993.

OBJECTIVE: To understand the current and potential role of state hospitals in serving geriatric patients, national trends in the use of state mental hospitals by adults age 65 and older were examined. METHODS: State hospital use by older adults in the 50 states and the District of Columbia was compared for the years 1984 and 1993 using published data from the Center for Mental Health Services. RESULTS: Nationally, the number of state hospital admissions and residents declined between 1984 and 1993, and the rate of decrease was greater for older adults than for younger adults. However, states varied considerably in the rate of decrease in the number of older adult state hospital residents and admissions and in the proportion of older adult patients diagnosed with an organic mental disorder. In ten states, the older-adult state hospital population increased. CONCLUSIONS: Although the national trend is toward a declining role for state hospitals in treatment and care of older adults, in several states the hospitals fill an important function in providing custodial care and acute care for this population.

Adult↗
PubMed1999

Fiscal outcomes of the closing of Central State Hospital: an analysis of the costs to state government.

This study reports estimates of the preclosure and postclosure costs of mental health services for patients directly affected by the closing of Central State Hospital. The data come from state budget documents and from the billing records of the community mental health centers serving the discharged clients. On average, it cost Indiana approximately $68,347 (in 1995 dollars) to provide 12 months of state hospital care for this client cohort in fiscal year 1993. In contrast, during the first year following the closure, the average per patient cost to the state was $55,417. When clients were served exclusively in community care settings, the average annual per patient cost was $40,618. The analyses suggest that the closing reduced the costs of caring for this cohort of patients by approximately 18.9%. A significant portion of the cost savings to the state mental health budget was achieved by shifting some of the direct patient care costs to Medicaid/Medicare.

Cost of Illness↗
PubMed1996

Clozapine eligibility among state hospital patients.

Connecticut State Hospital's entire resident population (n = 1,300) was screened on an arbitrary target day to determine eligibility for clozapine. Sixty percent of 803 patients with schizophrenia or schizoaffective disorder diagnoses met Food and Drug Administration (FDA)- approved criteria for clozapine use as judged by review of past medication trial records and by the responsible physicians. Eighty-eight percent of these patients were medically cleared, and of those cleared, 63 percent agreed to clozapine treatment. Of the patients who began a clozapine trial, 76 percent were still taking the drug 12 months later. Preliminary findings from a randomized trial of clozapine versus usual care (n = 227) indicate that discharge rates associated with clozapine and usual care do not differ. Once discharged, however, patients assigned to clozapine are less likely to be readmitted. Hence, clozapine may be more cost-effective than usual care. However, before savings can be realized, State governments will have to make up-front investments of approximately $140 million simply to give patients hospitalized on a single day a year's access to clozapine.

Adult↗
PubMed1976

Phasing out state hospitals -- a psychiatric dilemma.

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.

Acute Disease↗