The closing of central state hospital: Long-term outcomes for persons with severe mental illness

Abstract

This study examined the clinical/community functioning of long-stay patients following closing of a large state psychiatric hospital. Two overlapping samples were followed: (1) the tracking project collected information on patient location, treatment provision, legal contacts, and level of functioning (LOF) and followed all discharged patients and (2) the research study subsample, drawn from the final group of discharged patients, gathered information on quality of life (QOL), LOF, and general physical and mental health. At follow-up, patients were functioning equal to or better than prior to discharge. There were consistent improvements in QOL (especially safety and occupational satisfaction) and LOF (especially housing and income/benefits). Fewer than 27% of patients discharged into the community were rehospitalized, and fewer than 4% were either in jail or homeless after 24 months. The study demonstrates that even persons who have been hospitalized for extremely long periods can do well in the community.

Does Deinstitutionalization Increase Suicide?

“…This finding is in line with a greater risk of suicide among young deinstitutionalized patients served in a community mental health center (Pepper, Kirshner, and Ryglewicz 1981). In contrast, Bachrach (1996) and McGrew et al (1999) reported general improvements in the quality of life and functioning among patients discharged and treated in community settings due to the closure of state psychiatric hospitals.…”

“…The development of psychopharmacology beginning in the 1950s enabled community treatment of severe mental illness and reduced the need for long hospitalization (Morrissey 1989;Mechanic and Rochefort 1990;Grob 2001). With continued advances of psychotropic medications and treatment, community options might achieve similar or improved patient outcomes as suggested by Bachrach (1996) and McGrew et al (1999). In addition to technological innovations, however, strong ideological consensus, regulations of welfare programs such as Medicaid rules, and financial considerations have reportedly served as catalysts for rapid and ongoing public bed reductions (Cameron 1978;Gronfein 1985a;Mechanic and Rochefort 1990;Frank, Goldman, and Hogan 2003;Grob and Goldman 2006).…”

“…First, the U.S. studies examined only subgroups of persons with severe mental illness such as patients discharged from psychiatric hospitals (Haugland et al 1983) and former patients in state psychiatric hospitals who continued to receive treatment in the community after a discharge (Bachrach 1996;McGrew et al 1999). However, a reduced supply of public beds, ceteris paribus, may also affect persons who did not use public psychiatric hospitals previously but require intensive care in restricted settings as well as those who did not access treatment after a hospital discharge.…”

Sexual Networks and HIV Risk of People with Severe Mental Illness in Institutional and Community-Based Care

“…Although differences in the nature of sexual networks and risk behavior between the two types of settings exist, it is important to remember that it is common for clients with severe and persistent mental illness to move back-and-forth between institutional and community care settings (McGrew et al, 1999;Polgar and Morrissey, 1999). Indeed, the long-term trend towards deinstitutionalization has reduced the typical length of stay in long-term institutions (Dowdall, 1996) and increased the diversity of service settings where consumers receive treatment (Polgar and Morrissey, 1999).…”

Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

“…It has been especially driven by humanitarian concerns (Aderibigbe, 1997;Haug and Rossler, 1999;Thornicroft and Bebbington, 1989;Yohanna, 2013) responding to the improper treatment and human rights violations associated with long-term hospitalizations in big psychiatric institutions (Drew et al, 2011). Tens of thousands of long-term patients were discharged from mental hospitals as a consequence of deinstitutionalization (Honkonen et al, 1999;Talbott, 2004;Thornicroft and Bebbington, 1989), including a large number of patients with schizophrenia, some of whom were previously hospitalized for more than 20 years (Andrews et al, 1990;Barr and Parker, 1975;Donnelly et al, 1997;McGrew et al, 1999;Rothbard et al, 1999;Salokangas and Saarinen, 1998).…”