Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-15T07:12:58.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessing Psychiatric Care Settings: Hospitalization Versus Outpatient Care

Published online by Cambridge University Press:  10 March 2009

Mary L. Durham  and
John Q. La Fond
Mary L. Durham
Affiliation:
Kaiser Permanente Center for Health Research
John Q. La Fond
Affiliation:
Seattle University School of Law
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.

Type
Special Section: The Assessment of Psychiatry
Information
International Journal of Technology Assessment in Health Care , Volume 12 , Issue 4 , Fall 1996 , pp. 618 - 633
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Abramson, M. F.The criminalization of mentally disordered behavior: Possible side-effect of a new mental health law. Hospital and Community Psychiatry, 1972, 23, 101–07.Google ScholarPubMed
2.Alterman, A. I., Erdlen, F. R., McLellan, A. T., & Mann, S. C.Problem drinking in hospitalized schizophrenic patients. Addictive Behaviors, 1980, 5, 273–76.CrossRefGoogle ScholarPubMed
3.Anthony, W. A., Buell, G. J., Sharratt, S., & Althoff, M. E.Efficacy of psychiatric rehabilitation. Psychiatric Bulletin, 1972, 78, 447–56.Google Scholar
4.Anthony, W. A., Cohen, M. R., & Vitalo, R.The measurement of rehabilitation outcome. Schizophrenia Bulletin, 1978, 4, 365–83.Google Scholar
5.Anthony, W. A., & Jansen, M. A.Predicting vocational capacity of the chronically mentally ill: Research and policy implications. American Psychologist, 1984, 34, 537–44.Google Scholar
6.Anthony, W. A., & Liberman, R. P.The practice of psychiatric rehabilitation: Historical, conceptual, and research base. Schizophrenia Bulletin, 1986, 12, 542–59.Google Scholar
7.Arce, A. A., Tadlock, M., Vergare, M. J., et al. A psychiatric profile of street people admitted to an emergency shelter. Hospital and Community Psychiatry, 1983, 34, 812–17.Google Scholar
8.Aviram, U., & Segal, S. P.Exclusion of the mentally ill: Reflection of an old problem in new context. Archives of General Psychiatry, 1973, 29, 126–31.Google Scholar
9.Bachrach, L. L.An analytic review and sociological perspective. Rockville, MD: National Institute of Mental Health, 1976.Google Scholar
10.Bachrach, L. L.Young adult chronic patients: An analytic review of the literature. Hospital and Community Psychiatry, 1982, 33, 189–97.Google Scholar
11.Bachrach, L. L.What we know about homelessness among mentally ill persons: An analytic review and commentary. Hospital and Community Psychiatry, 1992, 43, 453–64.Google Scholar
12.Barbanel, J. Saving homeless from themselves: A new policy creates new disputes. New York Times, 12 7, 1985, 29.Google Scholar
13.Bassuk, E., Rubin, L., & Lauriat, A.Is homelessness a mental health problem? American Journal of Psychiatry, 1984, 141, 1546–50.Google ScholarPubMed
14.Bergman, H. C., & Harris, M.Networking with young adult chronic patients. Psychosocial Rehabilitation Journal, 1985, 8, 28–35.Google Scholar
15.Bond, G. R., Dincin, J., & Sitze, P. J.The effectiveness of psychiatric rehabilitation: A summary of research at Thresholds. Psychosocial Rehabilitation Journal, 1984, 7, 6–22.CrossRefGoogle Scholar
16.Brakel, S. J., Parry, J., & Weiner, B. A.The mentally disabled and the law, 2nd ed.Chicago: American Bar Foundation, 1985.Google Scholar
17.Braun, P., Kochasky, G., Shapiro, R., et al. Overview: Deinstitutionalization of psychiatric patients: A critical review of outcome studies. American Journal of Psychiatry, 1981, 138, 736–49.Google ScholarPubMed
18.Budson, R. D.The psychiatric halfway house. Pittsburgh: University of Pittsburgh Press, 1978.Google Scholar
19.Caffey, E. M., Jones, R. D., Diamond, L. S., et al. Brief hospital treatment of schizophrenia: Early results of a multiple-hospital study. Hospital and Community Psychiatry, 1968, 9, 282–87.Google Scholar
20.Caffey, E. M., Galbrecht, C. R., & Klett, C. J.Brief hospitalization and aftercare in the treatment of schizophrenia. Archives of General Psychiatry, 1971, 24, 81–86.CrossRefGoogle ScholarPubMed
21.Cohen, C. I.Poverty and the course of schizophrenia: Implications for research and policy. Hospital and Community Psychiatry, 1993, 44, 951–58.Google Scholar
22.Cohen, C. I., & Thompson, K. S.Homeless mentally ill or mentally ill homeless? American Journal of Psychiatry, 1992, 149, 453–64.Google Scholar
23.Cournos, F., Empfield, M., Horwath, E., et al. HIV prevalence among patients admitted to two psychiatric hospitals. American Journal of Psychiatry, 1991, 148, 1225–30.Google Scholar
24.Dennis, D.Exploring myths about ‘street people.’ Access 1990, 1990, 2, 1–3.Google Scholar
25.Deutsch, A.The mentally ill in America: A history of their care and treatment from colonial times, 2nd ed.New York: Columbia University Press, 1949.Google Scholar
26.Dion, G. L., & Anthony, W. A.Research in psychiatric rehabilitation: A review of experimental and quasi-experimental studies. Rehabilitation Counseling Bulletin, 1987, 31, 177–203.Google Scholar
27.Drake, R. E.Substance abuse among the chronically mentally ill. Hospital and Community Psychiatry, 1989, 40, 1041–46.Google Scholar
28.Drake, R. E., Osher, F. C., & Wallach, M. A.Alcohol use and abuse in schizophrenia: A prospective community study. Journal of Nervous and Mental Disease, 1989, 177, 408–14.CrossRefGoogle ScholarPubMed
29.Durham, M. L.The impact of deinstitutionalization on the current treatment of the mentally ill. International Journal of Law and Psychiatry, 1989, 12, 117–31.CrossRefGoogle ScholarPubMed
30.Durham, M. L., & La Fond, J. Q.The empirical consequences and policy implications of broadening the statutory criteria for civil commitment. Yale Law and Policy Review, 1985, 3, 395–446.Google Scholar
31.Durham, M. L., & La Fond, J. Q.A search for the missing premise of involuntary therapeutic civil commitment: Effective treatment of mentally ill. Rutgers Law Review, 1988, 40, 303–68.Google Scholar
32.Durham, M. L., & Pierce, G. L.Legal intervention in involuntary civil commitment: Final report. Bethesda, MD: National Institute of Mental Health, Center for Antisocial and Violent Behavior, 1988.Google Scholar
33.Eagle, P. F., & Caton, C. L. M. Homelessness and mental illness. In Caton, C. L. M. (ed.), Homeless in America. New York: Oxford University Press, 1990, 59–75.Google Scholar
34.ENKI Research Institute. A Study of California’s New Mental Health Law (1969–1971). 1972, 112.Google Scholar
35.Faulkner, L. R., Bloom, J. D., & McFarland, B. H.The effect of mental health system changes on civil commitment. Bulletin of the American Academy of Psychiatry and Law, 1985, 13, 345–53.Google Scholar
36.Fischer, P. J., & Breakey, W. R.Profile of Baltimore homeless with alcohol problems. Alcohol Health and Research World, 1987, 11, 36–41.Google Scholar
37.Fisher, W. H., Dorwart, R. A., Epstein, S., & Davidson, H.The role of the general hospitals in the privatization of inpatient treatment for serious mental illness. Hospital and Community Psychiatry, 1992, 43, 1114–19.Google ScholarPubMed
38.Glasscote, R. M., Cumming, E., Rutman, I. D., et al. Rehabilitating the mentally ill in the community: A study of psychosocial rehabilitation centers. Washington, DC: Joint Information Service of the American Psychiatric Association and the National Association for Mental Health, 1971.Google Scholar
39.Glasscote, R. M., Kraft, A. M., Glassman, S. M., et al. Partial hospitalization for the mentally ill: A study of programs and problems. Washington DC: Joint information Service of the American Psychiatric Association and the National Association for Mental Health, 1969.Google Scholar
40.Glick, I. D., Hargreaves, W. A., Drues, J., & Showstack, J. A.Short versus long hospitalization: A prospective controlled study: One year follow-up results for schizophrenic patients. American Journal of Psychiatry, 1976, 133, 509–14.Google Scholar
41.Gove, W., & Ludach, J. E.An intensive treatment program for psychiatric inpatients: A description and evaluation. Journal of Health and Social Behavior, 1969, 10, 236–55.Google Scholar
42.Graham, H. D.The civil rights era: Origins and development of national policy, 1960–1972. New York: Oxford University Press, 1992.Google Scholar
43.Grob, G. Deinstitutionalization: The American experience. Paper presented in Helsinki, Finland, 05 25, 1994.Google Scholar
44.Gudeman, H. E., Nelson, M. I., Kux, L. J., et al. Changing admission patterns at Hawaii State Hospital following the 1976 revision of the Hawaii mental health statutes. Hawaii Journal of Medicine, 1979, 65, 70–71.Google Scholar
45.Harding, C. M., Brooks, G. W., Ashikaga, T., et al. The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later; II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 1986, 144, 718–35.Google Scholar
46.Herz, M. I., Endicott, J., & Spitzer, R.Brief hospitalization: A two-year follow-up. American Journal of Psychiatry, 1977, 134, 502–07.Google Scholar
47.Hinds, J. T.Involuntary outpatient commitment for the chronically mentally ill. Nebraska Law Review, 1990, 69, 346, 358–65.Google ScholarPubMed
48.Holzer, C. E., Shea, B. M., Swanson, J. W., et al. The increased risk for specific psychiatric disorders among persons of low socioeconomic status. American Journal of Social Psychiatry, 1986, 4, 259–71.Google Scholar
49.In re Boggs, 522 N.Y.S. 2d 407, 408–09 (Sup. Ct. 1987).Google Scholar
50.Institute of Medicine. Homelessness, health and human needs. Washington, DC: National Academy Press, 1988.Google Scholar
51.Joint Commission on Mental Illness and Health. Action for mental health. New York: Basic Books, 1961.Google Scholar
52.Keiletz, I., & Hall, T.State statutes governing involuntary outpatient civil commitment. Mental Disability Law Reporter, 1985, 9, 378–97.Google Scholar
53.Kiesler, C. A.Public and professional myths about mental hospitalization: An empirical reassessment of policy-related beliefs. American Psychologist, 1982, 37, 1323–39.Google Scholar
54.Kiesler, C. A. Mental hospitals and alternative care: Noninstitutionalization as potential public policy. In Brown, P. (ed.), Mental health care and social policy. Boston: Routledge and Kegan Paul, 1985, 292–315.Google Scholar
55.Kiesler, C. A.Homelessness and public policy priorities. American Psychologist, 1991, 46, 1245–52.Google Scholar
56.Kiesler, C. A., & Sibulkin, A.Episodic rate of mental hospitalization: Stable or increasing? American Journal of Psychiatry, 1984, 141, 44–48.Google ScholarPubMed
57.Kiesler, C. A., & Sibulkin, A.Mental hospitalization: Myths and facts about a national crisis. Beverly Hills, CA: Sage, 1987.Google Scholar
58.Kozol, J.Rachael and her children: Homeless families in America. New York: Crown Publishers, 1988.Google Scholar
59.Kramer, M.Psychiatric services and the changing institutional scene. ADM 77–433, Mental Health Statistics: Series B, Analytical and Special Study Report No. 12. Rockville, MD: U.S. Department of Health, Education, and Welfare, 1977.Google Scholar
60.La Fond, J. Q.An examination of the purposes of involuntary civil commitment. Buffalo Law Review, 1981, 30, 499–535.Google Scholar
61.La Fond, J. Q., & Durham, M. L.Back to the asylum: The future of law and mental health policy in the United States. New York: Oxford University Press, 1992.Google Scholar
62.Lamb, H. R.What did we really expect from deinstitutionalization? Hospital and Community Psychiatry, 1981, 32, 105–09.Google Scholar
64.Langdon, J. K., & Kass, M. A.Homelessness in America: Looking for the right to shelter. Columbia Journal of Law and Social Problems, 1985, 19, 305–92.Google Scholar
65.Lehman, A. F., Ward, N. C., & Linn, L. S.Chronic mental patients: The quality of life issue. American Journal of Psychiatry, 1982, 139, 1271–76.Google ScholarPubMed
66.Lerman, P.Deinstitutionalization and the welfare state. New Brunswick, NJ: Rutgers University Press, 1982.Google Scholar
67.Link, B. G.Mental patient status, work and income: An examination of the effects of a psychiatric label. American Sociological Review, 1983, 47, 202–15.CrossRefGoogle Scholar
68.Mattes, J.The optimal length of hospitalization for psychiatric patients: A review of the literature. Hospital and Community Psychiatry, 1982, 33, 824–28.Google Scholar
69.McGarry, A. L., Schwitzgebel, K. R., Lipsitt, P., et al. Civil commitment and social policy: An evaluation of the Massachusetts Mental Health Reform Act of 1970. ADM 81–1011. Washington, DC: U.S. Department of Health and Human Services, 1981, 89–90.Google Scholar
70.Mechanic, D.Mental health and social policy: Initiatives for the 1980s. Health Affairs, 1985, 4, 75–88.Google Scholar
71.Mechanic, D.Correcting misconceptions in mental health policy: Strategies for improved care of the seriously mentally ill. Milbank Quarterly, 1987, 65, 203–30.Google Scholar
72.Miller, R. D.Outpatient civil commitment of the mentally ill: An overview and an update. Behavioral Science and Law, 1988, 6, 99–101.Google Scholar
73.Monahan, J.Predicting violent behavior: An assessment of clinical techniques. Beverly Hills, CA: Sage Publications, 1981.Google Scholar
74.Monahan, J., Caldeira, C., Friedlander, H. D., et al. Police and the mentally ill: A comparison of committed and arrested persons. International Journal of Law and Psychiatry, 1979, 2, 509–18.Google Scholar
75.Munetz, M. R.Modernization of a mental health act. I: Commitment patterns. Bulletin of the American Academy of Psychiatry and Law, 1980, 83, 89–92.Google Scholar
76.National Institute of Mental Health. Caring for people with severe mental disorders: A national plan of research to improve services. Bethesda, MD: NIMH, 1991.Google Scholar
77.Nicholson, R. A.Correlates of commitment status in psychiatric patients. Psychology Bulletin, 1986, 100, 241–46.Google Scholar
78.Olfson, M., Glick, I. D., & Mechanic, D. M.Inpatient treatment of schizophrenia in general hospitals. Hospital and Community Psychiatry, 1993, 44, 40–44.Google Scholar
79.Palermo, G. B., Smith, M. B., Liska, F. J.Jails versus mental hospitals: A social dilemma. International Journal of Offender Therapy and Comparative Criminology, 1991, 35, 97–106.Google Scholar
80.Pasamanick, B., Scarpetti, F., & Dinitz, S.Schizophrenics in the community: An experimental study of the prevention of hospitalization. New York: Appleton-Century Crofts, 1976.Google Scholar
81.Pierce County v. Western State Hospital, 97 Wash. 2d 264, 644 P. 2d 131, 1982.Google Scholar
82.Pierce, G. L., Durham, M. L., & Fisher, W. H.The impact of broadened civil commitment standards on admissions to state mental hospitals. American Journal of Psychiatry, 1985, 142, 104–05.Google Scholar
83.Rabkin, J.Criminal behavior of discharged mental patients: A critical review. Psychological Bulletin, 1979, 86, 23.Google Scholar
84.Rose, S. M.Deciphering deinstitutionalization: Complexities in policy and program analysis. Milbank Memorial Fund Quarterly, 1979, 57, 429–60.Google Scholar
85.Rossi, P. H., Wright, J. D., Fisher, G. A., & Willis, G.The urban homeless: Estimating composition and size. Science, 1987, 235, 1336–41.Google Scholar
86.Sadish, W. R., Lurigio, A. J., & Lewis, D. A.After deinstitutionalization: The present and future of mental health long-term-care policy. Journal of Social Issues, 1989, 45, 1–15.CrossRefGoogle Scholar
87.Schlesinger, M., & Dowart, B.Ownership and mental health services: A reappraisal of the shift towards privately owned facilities. New England Journal of Medicine, 1984, 311, 959–65.CrossRefGoogle Scholar
88.Segal, S. P., & Vander Voort, D. J.Daily hassles of persons with severe mental illness. Hospital and Community Psychiatry, 1993, 44, 276–78.Google Scholar
89.Steadman, H. J., Cocozza, J. J., Melick, M. E., et al. Explaining the increased arrest rate among mental patients: The changing clientele of state hospitals. American Journal of Psychiatry, 1978, 135, 816–20.Google Scholar
90.Stein, L. I., & Test, M. A.Training in community living: A follow-up look at a Gold-Award Program. Hospital and Community Psychiatry, 1976, 27, 193–94.Google Scholar
91.Straw, R.Meta-analysis of deinstitutionalization. Unpublished doctoral dissertation, Northwestern University, Chicago, IL, 1982.Google Scholar
92.Teplin, L. A.The criminalization of the mentally ill: Speculation in search of data. Psychological Bulletin, 1983, 94, 54–67.Google Scholar
93.Teplin, L. A.Criminalizing mental disorders: The comparative arrest rate of the mentally ill. American Psychologist, 1984, 39, 794–803.Google Scholar
94.Torrey, E. F.Nowhere to go: The tragic odyssey of the homeless mentally ill. New York: Harper and Row, 1988.Google Scholar
95.Ward, M. J.The snake pit. New York: Random House, 1949.Google Scholar
96. Washington Revised Code 71.05, 1979.Google Scholar
97.Weisman, G., Feirstein, A., & Thomas, C.Three-day hospitalization: A model for intensive intervention. Archives of General Psychiatry, 1969, 21, 620–29.Google Scholar
98.Yesavage, J. A., & Zarcone, V.History of drug abuse and dangerous behavior in inpatient schizophrenics. Journal of Clinical Psychiatry, 1983, 44, 259–61.Google Scholar