The place, if any, of the mental hospital in the community mental health care system

We have touched on the nature of mental disorders in the elderly, the systems of care now in use, described briefly some models of good programs and highlighted some of the defects in the health care delivery system. Patients over 65 comprise 4% of the admissions to community mental health centers, 4% of those admitted to outpatient departments, 5% of admissions to state and county mental hospitals (28% of the resident population), 7% of admissions to general hospitals and 10% of private hospitals admissions (U.S. Department of Health, Education and Welfare, 1980). Private and public mental hospitals have a positive role to play in the care of mental disorders in patients over 65 in the decade of the 1980s. Private mental hospitals provide geriatric programs for the acute disorders as well as the chronic. Mental hospitals provide a needed back-up function for community agencies and other institutions. They also provide care for patients with severe chronic psychoses, who are too disturbed for community placement. These are usually patients who have grown old in the institution. The hospitals care for remitting illness in patients who prefer to return for treatment with staff familiar with their therapy. The mental hospital also can provide 24-hour care for patients for whom day treatment does not suffice and for respite episodes also. The mental hospital is currently needed, and this need will continue throughout the decade of the 1980s, until community alternatives are in place and have proven able to care for all types of illness without a back-up facility, and demonstrations have proven such programs are economically feasible.