The new long-term patient in the public mental hospital

The authors examine the development and characteristics of a "new" long-term population in the public mental health system in Maryland. The findings do not substantiate concern over a large increase in the number of chronic patients in state hospitals in the next several years.     

A chronicle of change: A case study of the Connecticut mental health system

This article examines major changes in ideology, administrative structure, and leadership in mental health services in Connecticut from 1963–1987. Connecticut is used as a case study to present a historical account of the struggle to establish a more balanced, comprehensive, responsive, and effective public service system for the treatment of serious mental illness. Formal and informal decision-making, power relations, leadership, and the interplay of intra-system and extra-system forces in influencing policy outcomes are also considered.     

The new long-term patient in the public mental hospital: a follow-up

Of the 270 patients who had been hospitalized at least 1 year in Maryland public psychiatric facilities in 1976, 15% remained 7 years later. The authors' data provide evidence that a new long-term population is not accumulating in Maryland.     

The physician and his training in a public mental hospital

Conclusions It is fully appreciated regardless of the nature of a teaching and training program in a public mental hospital, or the interest and enthusiasm of those responsble for its inception and development, that there will be some physicians who are not benefited, and that in the last analysis much depends on the individual physician's initiative, willingness to take advantage of the opportunities offered him, and, if need be, to spend time and energy, outside socalled duty hours in developing himself.And finally, it must be stated and emphasized that it is recognized, that each public mental hospital has its own peculiar problems, advantages and handicaps, and that it is not assumed or inferred that the program which has been outlined is of value, in part, or as a whole, to any other hospital. However, it has been very useful at the Brooklyn State Hospital, and has, in a great measure, achieved its objectives.Presented at Interhospital Conference, Psychiatric Institute and Hospital, New York City, April 20–21, 1934.     

The role of psychiatry in the public mental health delivery system: An introduction

The papers which follow are revised and expanded versions of presentations made at the Conference on Improving Florida's Services for the Mentally Ill: The Role of Psychiatry, held in Tallahassee, Florida on October 7–8, 1986, and organized by the Florida Mental Health Institute, University of South Florida. The conference was sponsored by the Florida Department of Health and Rehabilitative Services through the Committee on Public Psychiatry. The authors and their organizational affiliations are listed below     

A state mental health system with no state hospital: the Vermont Feasibility Study

A comprehensive study of both the feasibility and the desirability of operating a state mental health system without a state hospital, except for a small forensic facility, was carried out in Vermont. Feasibility was examined in terms of client needs, service system capabilities, financing, human resource requirements, legal and rights protection issues, and political considerations. The study team concluded that developing comprehensive regional community support and rehabilitation services to replace the state hospital for all public mental health clients except forensic patients was both feasible and desirable since it would result in better services at a roughly equivalent cost to the state. The team also developed recommendations for optimizing the success of regionalization.     

Managed care in the public mental health system

The movement towards managed care in the public mental health system has surpassed efforts to develop a systematic literature concerning its theory, practice, and outcome. In particular little has been written about potential challenges and difficulties in translating managed care systems from their origins in the private sector to the delivery of public sector mental health services. This paper provides an overview of managed care definitions, organizational arrangements, administrative techniques, and roles and responsibilities using a theoretical framework adopted from economics referred to as principal-agent theory. Consistent with this theory, we assert that the primary function of the managed care organization is to act as agent for the payor and to manage the relationships between payors, providers, and consumers. From this perspective, managed care organizations in the public mental health system will be forced to manage an extremely complex set of relationships between multiple government payors, communities, mental health providers, and consumers. In each relationship, we have identified many challenges for managed care including the complexity of public financing, the vulnerable nature of the population served, and the importance of synchronization between managed care performance and community expectations for the public mental health system. In our view, policy regarding the role of managed care in the public mental health system must evolve from an understanding of the dynamics of government-community-provider-consumer agency relationships.Mary Masland, M.S.P.H., is Research Associate, Institute for Mental Health Services Research.Giorgio Piccagli, Ph.D., is Affiliated Investigator, Institute for Mental Health Service Research.This work was supported by the National Institute of Mental Health funded Center for Research on the Organization and Financing of Care for the Severely Mentally Ill (P50-MH43694).     

Role of psychiatrists in the public mental health system

This paper examines the contributions of the psychiatric profession within the public mental health system. Following a discussion of the current status of psychiatry and the public mental health delivery system, the author outlines a number of key recommendations regarding the appropriate role of psychiatrists in public systems. The author emphasizes the importance of the public mental health system in all areas of psychiatric practice.Dr. Miller was Commissioner of the Texas Department of Mental Health and Mental Retardation from February 1982 to April 1988, and served previously as State Mental Health Commissioner in Georgia and New Hampshire.This paper was a keynote address at the Conference on Improving Florida's Services for the Mentally Ill: The Role of Psychiatry, held on October 7–8, 1986 in Tallahassee, Florida. This conference was organized by the Florida Mental Health Institute, University of South Florida, and sponsored by the Florida Department of Health and Rehabilitative Services through the Committee on Public Psychiatry.     

The state mental hospital in transition: A review of principles

It is proposed here that the state hospitals will, through a transitional experience, become true community-oriented treatment facilities with the full range of services associated with a comprehensive community mental health center. The state hospital will have to continue to act in the role of a chronic disease hospital. It will have to continue to care for and innovate new treatment techniques for the hard-core refractory group of patients who suffer from persistent and severe disorganization of personality and severe asocial behavior due to psychotic causes. Even here one should be careful in the use of terms like chronic and intractable. Rehabilitation programs for these patients may in fact turn out to be feasible and the state hospitals may be the research centers where these solutions are found.