OBJECTIVES: This analytical review is intended to update the author's
earlier writings on the position of the state mental hospital within the
spectrum of services for long-term mental patients and to provide
perspective for the next generation of service planners. METHODS: Findings
and commentary are organized around four major questions. First, what is
the prevailing view of state mental hospitals today, and how does it
compare with the view that existed in the first half of this century?
Second, what individuals tend to be served in state mental hospitals today?
Third, what has been the fate of mentally ill persons who are no longer
served in state mental hospitals? Fourth, what is an appropriate role for
the state mental hospital in today's uncertain and rapidly changing systems
of care? Source material consists of periodical articles suggested in
MEDLINE searches, plus newspaper reports, recent books on mental health
service systems, and a variety of writings found in the "fugitive"
literature generally not indexed in traditional archives. RESULTS AND
CONCLUSIONS: Individual state mental hospitals vary in the composition of
their resident populations, the content of their services, and the overall
quality of their care. Although they have been superseded by
community-based service structures in some places, they continue in
general, as the result of their multifunctionality, to occupy a critical
place in systems of care. Renewed efforts to integrate them as full
partners within those systems must be undertaken.