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.

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With impending fiscal shortages limiting the growth of new community mental health services and the ability of mental hospitals to perform contemporary tasks remaining dubious, increased attention is being directed throughout the country to the role of state hospitals. Citizens and professionals in Massachusetts concluded that the needs of individuals now treated in mental hospitals are better met via community-based services as they become available than by services now provided in state hospitals. Consequently, public mental hospitals should be phased down over a 5-year period of time and their funds redeployed to community services. Among the factors affecting the success of this program shift are continuity of care for discharged patients, community acceptance of the mentally ill, and redeployment of personnel to community facilities.

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