State mental hospitals in Washington State in an era of policy change.

This paper examines changes in use of state mental hospitals in Washington State from July 1, 1990, to July 1, 1997. It focuses on the phenomenon of ongoing use of state mental hospital by patients over a period of years. Two panels of state mental hospital users were identified: one preceded and one followed implementation of state mental hospital downsizing policies. Though the number of adults per year using the state mental hospital decreased following policy implementation, there was a significant increase in the overall rate of ongoing use. A logistic regression for ongoing use with multiple individual and regional predictor variables is described.

Shifts in case mix and locus of mental health care for Washington State adults with severe mental illness.

The author describes outcomes of interventions that were aimed at decreasing high use of state hospitals. Research focused on changes in state hospital case mix and dynamics of use by individuals identified as "high utilizers" before and after the Washington State Mental Health Division (MHD) implemented a series of interventions designed to reduce use. A set of recommendations are offered for policymakers who plan interventions that shift the locus of care for severely and persistently mentally ill adults.

The evolving role of the state hospital in the care and treatment of older adults: state trend, 1984 to 1993.

OBJECTIVE: To understand the current and potential role of state hospitals in serving geriatric patients, national trends in the use of state mental hospitals by adults age 65 and older were examined. METHODS: State hospital use by older adults in the 50 states and the District of Columbia was compared for the years 1984 and 1993 using published data from the Center for Mental Health Services. RESULTS: Nationally, the number of state hospital admissions and residents declined between 1984 and 1993, and the rate of decrease was greater for older adults than for younger adults. However, states varied considerably in the rate of decrease in the number of older adult state hospital residents and admissions and in the proportion of older adult patients diagnosed with an organic mental disorder. In ten states, the older-adult state hospital population increased. CONCLUSIONS: Although the national trend is toward a declining role for state hospitals in treatment and care of older adults, in several states the hospitals fill an important function in providing custodial care and acute care for this population.

A state management planning system for addressing high levels of use of inpatient psychiatric services.

Research on psychiatric hospital admissions shows that a small group of patients use a disproportionate amount of inpatient services. In the late 1980s Washington State developed initiatives to target outpatient community mental health services to mentally ill persons with high rates of inpatient psychiatric service use. Services to the targeted group are provided by regional support networks under contract with the state. Diverse funding sources were consolidated to give the regional authorities flexibility to tailor funding to local needs, and new appropriations were tied to the region's commitment to increase capacity for community mental health services. To support those initiatives, the state developed a specialized client-focused database to identify individuals with high rates of hospital utilization, provide information to regional authorities about use of hospital services by those individuals, and assess whether they were receiving outpatient services. Analyses of statewide data showed wide variation among regions in hospital use and delivery of community services.

Influences on social work time expenditure in a voluntary inpatient psychiatric unit.

This article describes a study of social work time expenditure on a voluntary inpatient psychiatric unit in an inner-city, tertiary-care, teaching hospital that serves many publicly funded patients. The study examined the influence of a number of presenting problems, individual psychosocial factors, and demographic factors. Controlling for patient length of stay, four factors were found to influence time expenditure: (1) greater number of assessed psychosocial problems, (2) Asian ethnocultural background, (3) the interactive effect of being a Medicaid recipient or having a pending Medicaid application and needing placement in a structured living situation, and (4) referrals to child protective services.

Delayed discharges for medical and surgical patients in an acute care hospital.

A study of social work-coordinated discharges from medical and surgical units at a 387-bed tertiary care hospital in Seattle, Washington examines social, medical and organizational factors associated with overstays. Social and medical variables included an absence of social supports, multiple diagnoses, and patient/family decision-making problems. Though organizational factors within and outside the hospital were identified, the most frequent systems delay was due to lack of post-hospital beds.