Mental hospitals and alternative care: Noninstitutionalization as potential public policy for mental patients

In spite of a national policy of deinstitutionalization and outpatient care, the episodic rate of hospitalizing mental patients has increased in the last 20 yrs. 10 studies are reviewed in which serious psychiatric patients were randomly assigned to either inpatient care or some alternative mode of outpatient care. In no case were the outcomes of hospitalization more positive than alternative treatment. Typically, the alternative care was more effective regarding such outcome variables as psychiatric evaluation, probability of subsequent employment, independent living arrangements, and staying in school. Cost benefits were also noted. The studies provide clear evidence of the self-perpetuation of hospitalization in mental patients. Hospitalized Ss were more likely to be readmitted to the hospital than were alternative care Ss ever to be admitted. (29 ref)