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At least 19 recordsLinked to original sources

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

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

Pigmentation and musculoskeletal abnormalities in an aged state hospital population.

In a State hospital population, 686 patients (mean age, 65 years) were examined for patterned pigmentation on unexposed areas of the body. Of these patients, 285 (41.5 percent) met the criteria for pigmentation. There were no sex or age differences. Psychosis had been diagnosed in 96 percent of the pigmented group. All of the 239 patients examined orthopedically had vertebral malalignment greater than 15 degrees and often had other bony deformities. Nearly all of the pigmented group displayed dyskinetic activity. A possible mechanism for the production of the pigmentation-psychosis-skeletal deformity triad could be an alteration in the concentration of available melatonin. Continued research along these lines may lead to an effective means of pharmacologic treatment as well as better psychologic and physical care.

Adult

Effects of community mental health services on state hospital admissions: a clinical-demographic study.

In a study to refine the methodology for evaluating the impact of community mental health centers on state hospital admissions, data were gathered on hospital patients' demographic and clinical characteristics as well as on total admission rates. The study covered total inpatients admissions to a Pennsylvania state hospital from two counties for ten time periods, both before and after the establishment of local community mental health services. The authors found few consistent changes on most of the clinical and demographic factors for patients from either county, which indicated that the expansion of community services did not lead to changes in the type of patients admitted to the state hospital. However, the data did suggest that the expanded community services reduced the state hospital admission rates and shortened the length of hospital stay.

Adult

The effect of deinstitutionalization on the state hospital.

Recalling the important statement about the bankruptcy of the state hospital system and the need for a multitude of treatment settings made by Harry Solomon, M.D., in 1958, the authors acknowledge that the changes he prophesized have largely come about. Using the Massachusetts Mental Health Center as the model, they describe how an inpatient unit operates as part of a deinstitutionalized network of services for seriously ill patients. They discuss the five general types of patients admitted and the problems of providing adequate care to such a diverse population. Finally, they make a strong plea for the establishment of regional facilities to care for patients with unusual, complicated problems.

Boston

Kansas: a survey of state hospital admissions from an area served by a mental health center.

The authors made a survey of all admissions to Topeka (Kans.) State Hospital from a three-county catchment area over an 11-year period during which a private psychiatric clinic in the area assumed the functions of a comprehensive community mental health center. The center's activities brought a significant decrease in the number of direct admissions to the hospital from the catchment area. However, the center consistently referred more patients with psychotic disorders to the state hospital than would be expected on the basis of over-all state hospital admissions. Similarly, a high proportion of patients with organic brain syndromes were admitted directly to the hospital from the three-county area. The authors say the findings suggest that the public mental hospital still has an important role to play on the delivery of mental health services.

Analysis of Variance

Stigma and state hospital patients.

This study set out to measure the degree of social stigma experienced by discharged mental hospital patients and the extent to which these patients were viewed as a burden by family and friends. Predictors of stigma included social class and demographic factors, posthospital situation, emotional functioning, and use of aftercare facilities. However, available measures were able to account for little of the variance in stigma, and further research is suggested to establish more reliable predictors of mental patient stigmatization.

Adult

Explaining the increased arrest rate among mental patients: the changing clientele of state hospitals.

The arrest rates of nearly 2,000 psychiatric patients released from psychiatric centers in 1968 and those of nearly 2,000 patients released in 1975 were compared with the arrest rates of a group of 5,000 patients studied 25 years earlier. In general, arrest rates among the two recent samples were considerably higher than general population rates, primarily because of the large proportion of patients previously arrested. Other characteristics related to subsequent arrest were age and admitting diagnosis. One additional finding was that the number of patients with prior arrests had increased markedly over the years.

Adolescent

Phasing down state hospitals: integrated versus nonintegrated services.

Two mental health catchment areas in Massachusetts that were in the process of phasing down state hospitals and building up community care provided an opportunity for studying the effectiveness of an integrated service delivery model and a nonintegrated model. The area that integrated state hospital and community services was more successful in the phase-down. It had a lower admission rate, the patients who were readmitted did not stay as long, and patients discharged spent more time in the community. Specific adminstrative and clinical structures that facilitated the patients' progress included investing community-based, administrative authority in one person; having a centralized intake and referral system; and using case managers to follow the clients through the service delivery system.

Catchment Area, Health