What happened to deinstitutionalization: An analysis of revenue and quality of care, from 1980 to to 2000
Abstract
The purpose of deinstitutionalization was to release state psychiatric hospital patients to government-funded Community Mental Health Centers, to enhance their quality of care, while reducing the cost for services. The question is: did deinstitutionalization meet these goals? For decades, the report series, Mental Health United States, has provided a wealth of federal data on the revenue, services and patient characteristics of mental health services. Using these longitudinal data, from 1980 to 2000, the changes in revenue and other patient characteristics were studied, specifically for the institutions and organizations involved in the deinstitutionalization process. During this period, federally funded CMHCs were closed, and presidential administrations switched from Republican to Democrat. With respect to this, policy changes related to deinstitutionalization were analyzed. Did these data, aggregated for the United States as a whole, show whether or not revenue was saved, and patient services were enhanced? Over time, state psychiatric hospitals decreased both their inpatient and outpatient services, while other hospitals and mental health organizations increased especially in their outpatient services. However, by the year 2000, most hospitals and other care facilities had high occupancy levels that were unacceptable for quality of care. In addition, state psychiatric hospitals continued to serve mostly patients who were very severely mentally ill, when compared to other types of hospitals providing psychiatric care. Deinstitutionalization resulted in more patients being cared for, per dollar in revenue. It is difficult however, to measure accurately the actual amount of cost savings, since revenue sources were shifted from the government, to other programs and insurers. By the year 2000, it was apparent that deinstitutionalization had run its course, and that there would always be severely mentally ill people who would need long term care which only state psychiatric hospitals could provide.
Degree
Ph.D.
Advisors
Hogan, Purdue University.
Subject Area
Mental health|Public policy
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