Trends in state and county mental hospitals in the U.S. from 1970 to 1992

OBJECTIVE: The authors document changes in state mental hospitals from 1970 to 1992 in four areas: the number of hospitals, the average daily census, expenditures, and number of full-time-equivalent staff. METHODS: Data examined were derived from information collected in the Inventory of Mental Health Organizations and General Hospital Mental Health Services. RESULTS: From 1970 to 1992, the number of state hospitals dropped from 310 to 273, and their inpatient populations were drastically reduced (a 77 percent decrease), a continuation of a trend that began in 1956. Most of the reduction was due to the downsizing of existing hospitals rather than to hospital closings. A complex combination of medical, social, economic, legal, and political factors were responsible for the decrease. Although expenditures for state hospitals were nearly $8 billion in 1992, a 339 percent increase over 1970, the level of expenditures in current dollars has leveled off in recent years, and expenditures measured in constant dollars (adjusted for inflation) have actually decreased since the early 1980s. The number of professional patient care staff increased by about half, while nonprofessional staff decreased by about the same proportion. CONCLUSIONS: In the near future, it appears that state hospitals will continue to reduce their patient populations, although at a slower rate than in the past, and will continue to care for large numbers of persons who either are involuntarily admitted or do not have alternative living arrangements. However, state hospitals are likely to decrease in importance.