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Article
Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix
Systems and Psychosocial Advances Research Center Publications and Presentations
  • Jeffrey L. Geller, University of Massachusetts Medical School
  • William H. Fisher, University of Massachusetts Medical School
  • J. L. Wirth-Cauchon
  • Lorna J. Simon, University of Massachusetts Medical School
UMMS Affiliation
Department of Psychiatry
Date
8-1-1990
Document Type
Article
Medical Subject Headings
Adolescent; Adult; Aged; Community Mental Health Services; distribution; Costs and Cost Analysis; Deinstitutionalization; Diagnosis-Related Groups; Hospitals, Psychiatric; Hospitals, Public; Hospitals, State; Humans; Length of Stay; Massachusetts; Mental Disorders; Middle Aged; Patient Advocacy
Abstract

A 1978 consent decree affecting one region of Massachusetts mandated a drastic reduction of census at its state hospital, where considerable deinstitutionalization had already occurred over the prior two decades. The transfer of patients from hospital to community was to be accomplished through the unprecedented expansion of community resources. This second-generation deinstitutionalization effort achieved substantial census reduction but less than was envisioned. It was most effective in discharging geriatric and mentally retarded patients but far less effective with longterm and new chronic patients, many of whom continue to require repeated hospitalizations despite the availability of a comprehensive array of community-based services.

Rights and Permissions
Citation: Am J Psychiatry. 1990 Aug;147(8):982-7.
Related Resources
Link to Article in PubMed
PubMed ID
2115750
Citation Information
Jeffrey L. Geller, William H. Fisher, J. L. Wirth-Cauchon and Lorna J. Simon. "Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix" Vol. 147 Iss. 8 (1990) ISSN: 0002-953X (Linking)
Available at: http://works.bepress.com/jeffrey_geller/103/