Pattern of state mental health institute utilization : a descriptive analysis of patient characteristics in relation to state mental health policy

State mental health institutes, once almost the sole providers of psychiatric care in this country, now provide less than one-tenth of these services to persons defined as severely mentally ill. This study addresses the question of who seeks services at the institutes now and the characteristics of the modern day patient. Trends over a five-year period were examined for patients from a community mental health center catchment area who were admitted, discharged, and on long-term wards at a regional state mental health institute between 1980 and 1984.

Utilization rates of the Institute in the study area were less than one half of 1% of the total area population. The number of admissions had declined over the five years by 10%, with the major decline noted between 1980 and 1982. Concurrently, the number of discharges increased by 21% with the number of admissions nearly equal to the number of discharges by 1984. The greatest change in utilization occurred on long-term wards where a 50% decrease in number of patients was noted. Recidivism rates were consistent across the five-year period with 20-25% of all patients discharged requiring rehospitalization within 12 months.

The characteristics of the typical patient admitted or discharged showed that they were young adult male chronic patients as had been reported elsewhere in the literature. The length of hospital stay for these patients was generally less than 15 days, with the majority admitted due to violent and/or threatening behavior. By contrast, the typical long-term patient was over the age of 35 and had been in the Institute over one year.

These results suggested that (1) the problems once associated with institutionalization, e.g. overcrowding and long-term custodial care, have been significantly addressed, and (2) the modern day patient appears to be one who really needs to be there. These data were discussed in terms of policy planning for mental health services for the chronically mentally ill, with an overall conclusion made by the author that the process of reducing census at the state Institute has reached its maximum point of utility.