Social class and psychiatric inpatient care: a twenty-five year perspective.

Abstract

The authors present the major inpatient findings of the final survey conducted by the Trends in Mental Health project. This project, initiated by F.C. Redlich in 1975, is a limited follow-up of Hollingshead and Redlich's,Social class and mental illness. In spite of an enormous proliferation in psychiatric services in the survey's study region over the past 25 years, social class remains a major predictor of locus of inpatient care. In general, class II–IV patients have made significant shifts toward receiving private inpatient care. However, certain subgroups of lower-class patients — blacks, women and those with serious psychiatric disorders — still have limited access to private inpatient treatment. In addition, class V patients continued to exclusively utilize the public system. Deinstitutionalization and the shift of class IV and higher patients to private facilities have created a pooling of the most socially disabled patients on the public inpatient units. For example, almost 80% of all public inpatients were chronically unemployed and 60% lived alone when not hospitalized. The public policy implications of limited social access and the increased relative percentage of socially debilitated patients on public inpatient facilities are addressed.