Impact of aftercare services on recidivism of mental hospital patients

The subjects in this study were 129 patients released within a 2-year period from a large state hospital to a three-county area. Patient information on demographic, inhospital, and posthospital variables and the extent of participation in an aftercare program was collected from existing records. The relationship between the community support system available to the patient and recidivism was determined. Three criteria of recidivism were used: readmission within 1 year following discharge, number of days in the community within 1 year following discharge, and number of days to first readmission. No single predictor was adequate in predicting hospital readmission. When the effects of confounding variables were eliminated using multiple-regression techniques, the amount of aftercare received was an important factor in predicting recidivism. However, current situational factors appeared to be more important predictors of recidivism than receipt of aftercare services.     

A multivariate analysis of dropout status by length of stay in a rural community mental health center

Homogeneity and other characteristics of rural community mental health center adult, outpatient dropouts were investigated with particular attention to length of stay. Analyses of 93 cases during a one year period revealed that qualities of the therapist discriminated short-term dropouts from long-term dropouts and long-term terminators. The client's chronicity discriminated short-term dropouts from short-term terminators. Dropouts were not found to be a homogeneous group. While therapist characteristics may be important in predicting termination status in long-term stays, the termination status of short-term clients may be determined primarily by the severity of the client's problems and whether or not they have received previous treatment.     

The relationship between community resources and state hospital recidivism.

OBJECTIVE: The authors examined the propositions that a revolving state hospital door is an inevitable consequence of deinstitutionalization and that enhancing resources for community-based care can limit this phenomenon. METHOD: They analyzed the recidivism patterns of state hospital patients in a region of Massachusetts where, because of a federal court consent decree, the level of funding for community programs was more than twice as high as it was in other regions in the state and compared the pattern of recidivism in this region with that observed in the other areas of the state. RESULTS: Despite the fact that the average daily state hospital census in the resource-rich region was only half that of the other regions, longitudinal data on hospital use showed that the readmission patterns were similar in all state regions. CONCLUSIONS: The authors suggest that attributes of serious and persistent mental illness may have more effect on hospital readmission patterns than service system variables.     

Effectiveness of a mental health court in reducing criminal recidivism and violence

OBJECTIVE: In response to the large-scale involvement of people with mental disorders in the criminal justice system, many communities have created specialized mental health courts in recent years. However, little research has been done to evaluate the criminal justice outcomes of such courts. This study evaluated whether a mental health court can reduce the risk of recidivism and violence by people with mental disorders who have been arrested. METHOD: A retrospective observational design was used to compare the occurrence of new criminal charges for 170 people who entered a mental health court after arrest and 8,067 other adults with mental disorders who were booked into an urban county jail after arrest during the same interval. A matching strategy based on propensity scores was used to adjust analyses for nonrandom selection into mental health court. RESULTS: Propensity-weighted Cox regression analysis, controlling for other potential confounding variables (demographic characteristics, clinical variables, and criminal history), showed that participation in the mental health court program was associated with longer time without any new criminal charges or new charges for violent crimes. Successful completion of the mental health court program was associated with maintenance of reductions in recidivism and violence after graduates were no longer under supervision of the mental health court. CONCLUSIONS: The results indicate that a mental health court can reduce recidivism and violence by people with mental disorders who are involved in the criminal justice system.     

A multivariate analysis of PET activation studies

In this paper we present a general multivariate approach to the analysis of functional imaging studies. This analysis uses standard multivariate techniques to make statistical inferences about activation effects and to describe the important features of these effects. More specifically, the proposed analysis uses multivariate analysis of covariance (ManCova) with Wilk's lambda to test for specific effects of interest (e.g., differences among activation conditions), and canonical variates analysis (CVA) to characterize differential responses in terms of distributed brain systems. The data are subject to ManCova after transformation using their principal components or eigenimages. After significance of the activation effect has been assessed, underlying changes are described in terms of canonical images. Canonical images are like eigenimages but take explicit account of the effects of error or noise. The generality of this approach is assured by the general linear model used in the ManCova. The design and inferences sought are embodied in the design matrix and can, in principle, accommodate most parametric statistical analyses. This multivariate analysis may provide a statistical approach to PET activation studies that 1) complements univariate approaches like statistical parametric mapping, and 2) may facilitate the extension of existing multivariate techniques, like the scaled subprofile model and eigenimage analysis, to include hypothesis testing and statistical inference. © 1996 Wiley-Liss, Inc.     

The mental hospital magazine

Psychiatric Quarterly -     

Changing a mental hospital

Over the course of 4 years, from 1974 to 1978, Harlem Valley Psychiatric Center was transformed from an inpatient-custodial to a community-based, active treatment facility. This was accomplished despite a budget reduction of nearly one-fourth during this period. This article describes the stratagems that enabled this to be accomplished as well as the problems encountered in the process.Yoosuf A. Haveliwala, M.D. is presently Director of Creedmoor Psychiatric Center, Queens Village, N.Y. and Adjunct Professor of Psychiatry at New York Medical College, N.Y. During the time of this study he was Director of Harlem Valley Psychiatric Center, Wingdale, N.Y.     

Alternative to mental hospital treatment. II. Economic benefit-cost analysis

A cost-benefit analysis should be seen not as a mechanism for deciding mechanically on the allocation of funds and resources among programs but as a structure for weighing advantages and disadvantages (that is, for organizing knowledge). Considering all the forms of benefits and costs that we were able to derive in monetary terms, the experimental program provided both additional benefits and additional costs as compared with the conventional treatment. However, the added benefits, some +1,200 per patient per year, are nearly +400 more per patient per year than the added costs. A number of the forms of benefits and costs that we have measured in quantitative but nonmonetary terms show additional advantages of the community-based experimental program. The generalizability of a single experiment is limited, but the methodologies developed may be useful if their proper role is appreciated.     

A survey of factors related to mental hospital readmissions.

The authors followed up 107 patients selected at random from those discharged from a southern state mental hospital in fiscal year 1972-73. They attempted to differentiate those who were readmitted to the hospital from those who were not on the basis of 52 factors, both personal and environmental, and also compared those who misused alcohol with those who did not. In their sample, 36 of the patients returned to theinstitution, and 71 did not. One of the findings was that in both the total sample and in the nonalcoholic subsample, those readmitted more often received income ffrom sources other than their own employment or the employment of someone in their household. They also tended to be single, separated, or divorced. In both the alcoholic and nonalcoholic subsamples, those readmitted reported more contacts with the community mental health center after their discharge than those not readmitted. In the total sample, the readmitted patients engaged in fewer leisure-time activities and were more likely to report a drinking problem.