Factors associated with the discharge of patients from a long-term state psychiatric hospital

Abstract

The study discussed in this article describes the characteristics of 188 patients who were residing in a state psychiatric hospital on July I, 1995, and identifies the patient-related factors associated with the 74 patients who were discharged within four years of the survey date. Because of different criteria for discharge between patients admitted by their legal guardians and those committed by the criminal courts, separate analyses were conducted on the two groups. Overall, court-committed patients who were discharged demonstrated higher levels of psychiatric stability and nondangerous behaviors than guardianship patients who were discharged. Key words, discharge; forensic patients; longterm hospitalization; psychiatric hospitals It is widely recognized that most people with mental illnesses can live in the community with varying levels of support. Some states, such as Vermont, even have sought to close their state psychiatric hospitals (Carling, Miller, Daniels, & Randolph, 1987). Other states contend that a small number of people with severe mental illnesses require long-term hospitalization (Belcher & DeForge, 1997; Lamb & Shaner, 1993). Pepper and Ryglewicz (1985) identified three groups who are likely to need long-term psychiatric hospitalization: (1) those experiencing persistent psychoses or engaging in behaviors that are unmanageable in the community, (2) some elderly patients who are unable to be placed in nursing homes, and (3) forensic patients. Recognizing the need for long-term hospitalization, the Missouri Department of Mental Health (MDMH) continues to operate four long-term psychiatric hospitals for adults. According to unpublished MDMH data, 862 patients were residing in MDMH long-term psychiatric facilities on July 1, 1997, and had been hospitalized a mean of 5.9 years (SD = 7.2). Forensic patients were the largest group, assigned to 64.3 percent of the total beds. Individuals found by Missouri criminal courts to be not guilty by reason of insanity (NGRI) were the largest subgroup of forensic patients, assigned to 54.6 percent of the beds. Patients admitted voluntarily, by their legal guardians, or through civil commitment were assigned to the remaining 35.7 percent of beds. Patients ages 65 and above constituted 5.3 percent of all patients. Despite the continued use of long-term psychiatric hospitalization for some patients in Missouri and in other states, relatively little has been reported about patients who reside in state psychiatric hospitals for extended periods and the factors associated with their discharge. Research usually focuses on patients discharged from acute psychiatric hospitals. For example, studies of lengths of psychiatric hospitalization generally have included patients who were hospitalized for two months or less (for example, Bezold, MacDowell, & Kunkel, 1996; Kiesler, Simpkins, & Morton, 1990). Two studies were identified that compared the characteristics of long-term patients who were discharged with those not discharged. Callahan and Silver (1998) followed a sample of 529 NGRI patients from four states from the date of hospitalization at the time of NGRI acquittal to five years postacquittal. Within five years of acquittal, 60 percent were discharged into the community, although discharge rates ranged from 30 percent to 80 percent among the four states. Demographic, diagnosis, criminal offense, social support, and historical factors associated with discharge also varied widely across the four states. In Connecticut none of the factors differentiated discharged and nondischarged patients. In Maryland those discharged were likely to have a major disorder other than schizophrenia. In Ohio those discharged were less likely to have committed a serious offense. In New York discharged patients were more likely to be female, to be white, to have a high school diploma, to have a major disorder other than schizophrenia, and to have had fewer prior hospitalizations. …