Beyond deinstitutionalization: a new class of facilities for the mentally ill

There are an estimated 15 persons per 100,000 population who cannot be cared for in community programs meant to replace state mental hospitals. In a review of patients at their hospital & in affiliated community settings, 30 patients -- 6% of the treated population -- required special care not currently available. Special care patients are divided into 5 groups: psychotic, medically ill persons who need nursing care; mentally ill retarded persons who require education & behavior therapy; brain damaged, assaultive persons who can be treated in residential units; psychotic, assaultive persons who require secure "hospital-like" care; & disruptive psychotic persons who need a structured living facility. A 25-30 patient unit for each of the 5 groups that could be set up on the grounds of state hospitals, schools for the retarded, nursing homes, & in vacant sections of general hospitals is suggested. A few pilot programs should be tried to determine what the units will cost & how funding might be attracted. The movement to get patients out of state hospitals is not a failure; in Mass only about 5% of former state hospital patients, a total of 800-1,000 persons, need long-term specialized care. 1 Table, 24 References. Modified AA.