CMHS data highlights on: availability of psychiatric beds, United States: selected years, 1970-1990.

Despite the decrease from 474,190 to 250,541 between 1970 and 1990 in the overall number of non-Federal psychiatric beds (excluding "scatter" beds in non-Federal general hospitals), the trend was by no means constant over time. Between 1970 and 1982, a period of rapid deinstitutionalization of State mental hospitals, the number of beds in all organizations combined dropped precipitously from 474,190 to 222,666, led by State mental hospitals which decreased from 413,066 to 140,140 beds. This was the height of the community mental health center movement and the prevailing view of mental health administrators was that persons with mental illness could be cared for better in the community, rather than at State mental hospitals, far from their homes. Thus, some hospitals closed altogether, and many others closed wards and units as part of the downsizing process. Contrary to a decrease in the number of beds in State mental hospitals during the 1970-82 period, the number of beds in other organization types, in particular private psychiatric hospitals and separate psychiatric services of non-Federal general hospitals, remained relatively constant. The net result was a substantial decrease in the overall number of non-Federal psychiatric beds. In the 1982-90 period, a different phenomenon occurred. The number of beds in State mental hospitals was continuing to decline, but at a slower rate from 140,140 to 98,789, while the number of beds in other types of mental health organizations, particularly private psychiatric hospitals and separate psychiatric inpatient services of non-Federal general hospitals, expanded somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

Staffing of mental health organizations, United States, 1988.

Between 1986 and 1988, the number of full-time equivalent (FTE) staff employed in specialty mental health organizations in the United States increased 7 percent, from 494,515 to 531,067. Much of this increase could probably be attributed to the increase in number of mental health organizations during this period, from 4,747 to 4,930. With the exception of State mental hospitals and VA psychiatric organizations, all of the other types of mental health organizations showed varying amounts of increase in FTE staff with the most notable gains being reported by private psychiatric hospitals, residential treatment centers for emotionally disturbed children, and multiservice mental health organizations. Of the 531,067 FTE staff employed in mental health organizations in 1988, 72 percent were classified as patient care staff and 28 percent as administrative and support staff. State mental hospitals and VA psychiatric organizations had slightly higher percentages of administrative and support staff (35 and 32 percent, respectively). Seventy percent or more of the staff employed in the various types of specialty mental health organizations in 1988 worked on a full-time basis, the two exceptions being freestanding psychiatric outpatient clinics and non-Federal general hospital psychiatric services in which full-time staff represented only 52 percent and 69 percent, respectively, of all staff. For the most part, the majority (50 percent or more) of each of the staff disciplines employed in mental health organizations worked on a full-time basis. The major exceptions were psychiatrists and other physicians, most of whom worked either on a part-time or trainee basis.

Patient care episodes in mental health organizations, United States: selected years from 1955 to 1988.

The 4,930 mental health organizations providing mental health services in the United States during 1988 (excluding the Territories) generated just over 8.3 million patient care episodes (table 1). However, in order to compare 1988 data with those for other years dating back to 1955, outpatient and partial care programs administered by the Department of Veterans Affairs (formerly the Veterans Administration) (VA) need to be omitted (table 2). Thus the 7.8 million patient care episodes in 1988 (exclusive of VA outpatient and partial care programs) represented a more than four-fold increase over the 1.7 million patient care episodes in mental health organizations observed more than three decades earlier in 1955. The major shifts in patient care episodes over the period from 1955 to 1988 have been from inpatient to ambulatory care services in mental health organizations, and from State and county mental hospitals to community-based mental health organizations. For example, in 1955, 77 percent of all patient care episodes were inpatient episodes, and the remaining 23 percent were outpatient episodes. By 1988, inpatient episodes constituted only 28 percent of the total, while 66 percent were outpatient episodes, and 6 percent were partial care episodes (table 2 and figure 1). However, the relative distribution of inpatient, outpatient, and partial care episodes has been relatively stable since 1975. From 1955 to 1988, the primary locus of inpatient care shifted from State and county mental hospitals to non-Federal general hospitals. Also, by 1988, the locus of over one-half of the outpatient care episodes and almost two-thirds of the partial care episodes was in multiservice mental health organizations.

Availability and distribution of psychiatric beds, United States and each state, 1988.

The total number of non-Federal and Department of Veterans Affairs (VA) inpatient and residential treatment psychiatric beds in mental health organizations in the United States increased by almost 2 percent between 1986 and 1988, from 267,613 to 271,923. Excluding VA psychiatric beds in both years, the number of beds increased from 240, 739 in 1986 to 246,181 in 1988 (2.3 percent). This was in contrast to a 3 percent decrease observed nationally in all non-Federal hospital beds (psychiatric and other) during the 1986-88 period. As a result, non-Federal psychiatric beds comprised 21 percent of non-Federal hospital beds in 1988, compared to 20 percent in 1986. The overall growth in psychiatric beds between 1986 and 1988 was due to increases in number of psychiatric beds in private psychiatric hospitals, separate psychiatric services of non-Federal general hospitals, residential treatment centers for emotionally disturbed children, (RTCs), and multiservice mental health organizations, which more than offset decreases in psychiatric beds in State and county mental hospitals and VA mental health services. Between 1986 and 1988, the national pattern of an increase in psychiatric beds was reflected in 30 States, while the remaining 20 States and the District of Columbia showed decreases in psychiatric beds. Among the States, the availability of psychiatric beds, measured by bed rates per 100,000 civilian population, varied considerably in 1988. Thirty States and the District of Columbia had 100 or more beds per 100,000 civilian population, while 6 States had rates of fewer than 75 beds. Although the number of State and county mental hospital beds decreased between 1986 and 1988, these organizations accounted for the largest percentage of all psychiatric beds in 1988 (39 percent). The separate psychiatric services of non-Federal general hospitals ranked second in number of psychiatric beds in 1988, with 18 percent of the total followed by private psychiatric hospitals, with 16 percent; VA mental health services, with 10 percent; residential treatment centers for emotionally disturbed children with 9 percent; and multiservice mental health organizations, with 8 percent.

Outpatient care programs of mental health organizations, United States, 1988.

In 1988, 2,989 (60 percent) of the 4,961 mental health organizations in the United States (including the territories) offered outpatient care programs. A total of 5.8 million patient care episodes were generated by these organized outpatient programs. These episodes included 3.1 million outpatient additions, produced 54 million outpatient visits, and represented 67 percent of all patient care episodes in mental health organizations in 1988. Although the number of mental health organizations with outpatient care programs increased by less than one percent between 1986 and 1988, the number of outpatient additions showed an 11 percent gain during this period. Multiservice mental health organizations were the primary locus of outpatient care in 1988, accounting for 41 percent of the 2,989 mental health organizations providing this care. Ranking next in this respect, were free-standing psychiatric outpatient clinics, and the separate psychiatric outpatient services in non-Federal general hospitals, with 25 and 16 percent, respectively, of the total outpatient care programs. In general, these three organization types had similar rankings with respect to the volume of the outpatient caseload. By definition, all of the freestanding psychiatric outpatient clinics provided outpatient care, and almost all of the VA mental health programs and multiservice mental health organizations also offered this care (99 and 92 percent, respectively). In contrast, psychiatric outpatient care was available in only 37 percent of non-Federal general hospitals with separate psychiatric services, 36 percent of private psychiatric hospitals, 29 percent of State mental hospitals, and 22 percent of RTCs for emotionally disturbed children. Outpatient care was available in mental health organizations in all States in 1988, with every State having at least two or more organization types providing this service. In general, the most populous States had the largest number and the greatest variety of mental health organizations with outpatient care programs. Of the 2.87 million clients receiving outpatient care in mental health organizations at the end of 1988, 23 percent were under 18 years of age, 68 percent were 18 to 64, and 9 percent were 65 and older. Male outpatient clients slightly outnumbered female clients. The majority (77 percent) of the outpatient clients were white, with blacks representing 21 percent; native Americans and Asians/Pacific Islanders, the remaining two percent. Eleven percent of the total client population were reported to be of Hispanic origin.(ABSTRACT TRUNCATED AT 400 WORDS)

Staffing of mental health organizations, United States, 1986.

Between 1984 and 1986, the number of full-time equivalent (FTE) staff employed in specialty mental health organizations in the United States increased 12 percent from 440,925 to 494,591. Much of this increase could probably be attributed to the increase in the number of mental health organizations during this period from 4,438 to 4,747. With the exception of freestanding psychiatric outpatient clinics, which showed a 1 percent decrease, all of the other mental health organization types showed varying amounts of increase in FTE staff, with the most notable gains reported by private psychiatric hospitals, RTCs for emotionally disturbed children, and multiservice mental health organizations. Of the 494,591 FTE staff employed in mental health organizations in 1986, 70 percent were classified as patient care staff and 30 percent as administrative and support staff. Private psychiatric hospitals, State mental hospitals, and freestanding psychiatric outpatient clinics had slightly higher percentages of administrative and support staff (40, 35, and 33 percent, respectively), with consequent smaller percentages of patient care staff (60, 65, and 67 percent, respectively). For all other organization types, the percentages of patient care staff were higher, varying from 70 to 87 percent. Professional patient care staff constituted 47 percent of all FTE staff in mental health organizations in 1986, and other mental health workers (less than B.A.) represented only 23 percent of the total. Among each of the organization types, however, the percentages of professional patient care staff were generally higher, and the percentages of other mental health workers lower, with the major exception of State mental hospitals. Seventy-five percent or more of the staff employed in the various types of specialty mental health organizations in 1986 worked on a full-time basis, with the exception of freestanding psychiatric outpatient clinics and the separate psychiatric services of non-Federal general hospitals in which full-time staff represented only 53 and 67 percent of all staff, respectively. For the most part, a majority (50 percent or more) of each of the staff disciplines employed in specialty mental health organizations worked on a full-time basis. The major exceptions were psychiatrists and other physicians, most of whom worked either on a part-time or a trainee basis.

Availability and distribution of psychiatric beds, United States and each state, 1986.

The total number of psychiatric beds in mental health organizations in the United States increased 2 percent between 1984 and 1986, from 262,673 to 267,613. This was in contrast to a 4 percent decrease observed nationally in all non-Federal hospital beds between 1984 and 1986. As a result, non-Federal psychiatric beds comprised 20 percent of non-Federal hospital beds in 1986, compared to 19 percent in 1984. The overall growth in psychiatric beds between 1984 and 1986 was due to increases in psychiatric beds in VA medical centers, private psychiatric hospitals, and residential treatment centers for emotionally disturbed children (RTCs) which more than offset smaller decreases in psychiatric beds noted in State and county mental hospitals, multiservice mental health organizations, and separate psychiatric services of non-Federal general hospitals. Between 1984 and 1986, the national pattern of an increase in psychiatric beds was reflected in 31 States, while the remaining 19 States and the District of Columbia showed decreases in psychiatric beds during this period. Among the States, the availability of psychiatric beds, measured by bed rates per 100,000 civilian population, varied substantially in 1986. Twenty-seven States and the District of Columbia had 100 or more beds per 100,000 population, while 8 States had fewer than 75 beds per 100,000 population. Although the number of State and county mental hospital beds decreased between 1984 and 1986, these facilities accounted for 45 percent of all psychiatric beds in 1986. In the number of psychiatric beds available, State and county mental hospitals predominated in all but seven States. Nationally, the separate psychiatric inpatient services of non-Federal general hospitals ranked second in number of psychiatric beds in 1986, with 17 percent of the total; followed by private psychiatric hospitals, with 11 percent; VA medical centers, with 10 percent; RTCs, with 9 percent; and multiservice mental health organizations, with 8 percent.

Patient care episodes in mental health organizations, United States: selected years between 1955 and 1986.

The 4,747 mental health organizations (excluding territories) providing mental health services in the United States during 1986 generated almost 7.9 million patient care episodes including those in Veterans Administration outpatient and partial care programs. However, in order to make comparisons between 1986 data and all years dating back to 1955, outpatient and partial care programs administered by the Veterans Administration (VA) are omitted. Thus the 7.5 million patient care episodes (exclusive of the aforementioned VA programs) represented a more than four-fold increase over the 1.7 million patient care episodes in mental health organizations observed 31 years earlier in 1955. The major shifts in patient care episodes over the 1955-1986 period have been from inpatient to ambulatory care services in mental health organizations, and from State and county mental hospitals to community-based mental health organizations. For example, in 1955, 77 percent were inpatient care episodes, and the remaining 23 percent were outpatient episodes; by 1986, inpatient care episodes constituted only 27 percent of the total, while 68 percent were outpatient episodes, and 5 percent were partial care episodes. Moreover, between 1955 and 1986, the primary locus of inpatient care episodes shifted from State and county mental hospitals to non-Federal general hospitals, and by 1986 over one-half of the outpatient care episodes and about two-thirds of the partial care episodes occurred in the multiservice mental health organizations.

Private psychiatric hospitals, United States: 1983-84 and 1986.

In 1986, a total of 314 private psychiatric hospitals provided inpatient services in 47 States and the District of Columbia (D.C.); 114, outpatient care services in 35 States and D.C.; and 102, partial care services in 26 States and D.C. Between 1983 and 1986, the total number of inpatient, outpatient, and partial care episodes in these hospitals increased from 333,731 to 483,284. During the 1983-86 period, the number of private psychiatric hospitals increased from 220 to 314. Almost all of this increase occurred among hospitals operating on a for-profit basis. By 1986, these hospitals represented three-quarters of all private psychiatric hospitals. With the exception of small not-for-profit hospitals, all bed-size groups in private psychiatric hospitals increased between 1983 and 1986. The number of beds in private psychiatric hospitals increased 41 percent, from 21,474 in 1983 to 30,201 in 1986. Similarly, the number of inpatient additions increased from 164,732 to 234,663 in this period, and inpatients at end of year increased from 16,079 to 24,591. The number of outpatient additions increased by more than half, from 77,589 in 1983 to 123,355 in 1986, and the outpatients at the end of the year rose from 79,598 to 135,606 (70 percent). In the same period, the number of partial care additions increased from 5,642 to 8,820, and partial care patients at the end of the year rose from 3,218 to 3,856 (20 percent). In the 1986 year-end inpatient caseload, males slightly outnumbered females, and the patient population was predominantly white, non-Hispanic. About two-fifths of the patients were under age 18, slightly over half were age 18-64 years, and 8 percent were age 65 or older. Mental illness was the major disability, with alcohol and drug abuse a distant second. By comparison, a smaller proportion of patients were under age 18 in 1983 (31 percent), and a larger proportion were age 18-64 (61 percent). In outpatient and partial care services, a more even distribution of the sexes was generally observed. Proportionately fewer outpatients were under age 18, more were between 18 and 64, and fewer were diagnosed with alcohol and drug abuse, compared with inpatient services. Also, proportionately more outpatients were Hispanic. Concomitant increases occurred in the number of full-time equivalent (FTE) staff, as well as in the amount of money expended by private psychiatric hospitals. FTE staff increased from 42,202 in June 1984 to 58,912 in November 1986.(ABSTRACT TRUNCATED AT 400 WORDS)

Forensic mental health services provided by mental health organizations, United States, 1985.

Results from the 1985 NIMH Inventory show that 1,339 (43 percent) of the 3,118 mental health organizations surveyed provided mental health services to mentally disordered adult offenders. Almost three-fifths of these forensic services were in multiservice mental health organizations, 23 percent were in freestanding psychiatric outpatient clinics, 14 percent in State mental hospitals, 4 percent in private psychiatric hospitals, and less than 2 percent in residential treatment centers for emotionally disturbed children and freestanding psychiatric partial care organizations. About two-thirds of the 289 State mental hospitals provided forensic services; 55 percent of the 1,383 multiservice mental health organizations and 40 percent of the 756 freestanding psychiatric outpatient clinics offered these services. Psychiatric assessment was the forensic service provided by the largest number of mental health organizations. This was followed, in order, by consultation to law enforcement staff and attorneys, psychiatric outpatient care, monitoring of medication, emergency mental health care, inpatient/residential care, partial care, and emergency detention. About 200,000 mentally disordered offenders received psychiatric assessment services from mental health organizations; slightly over 100,000 were provided psychiatric outpatient care, and smaller numbers of clients received other types of forensic services. A total of 14,538 full-time equivalent (FTE) patient care staff were involved in the delivery of forensic services. In addition, State mental hospitals reported 4,525 FTE administrative and support staff serving forensic patients. Special funding for forensic services, totaling $639 million, was received by just over half of the mental health organizations with these services. About four-fifths of this funding came from State mental health agencies, with the remainder provided by sources such as State correctional agencies, State courts or other State sources, city/county jails, city/county courts, and other local public sources.

Community mental health centers and the treatment of severe mental disorder.

Between 1970 and 1975 the number and rate of admissions to community mental health centers of people given a diagnosis of schizophrenia increased dramatically. However, the proportion of patients with schizophrenia admitted to community mental health centers declined because the increase in the rate of admissions of patients with schizophrenia was diluted by the large increase in the rate of admissions of patients with other diagnoses. The authors review the data on trends in admissions of patients with a diagnosis of schizophrenia in the context of an expanding system of mental health services characterized by changes in the locus of care.