Faculty Bibliography

OBJECTIVE:Dramatic increases in lengths of stay for general hospital psychiatric patients in New York City in recent years have raised speculation that general hospitals are assuming a large responsibility for care of the chronically mentally ill. This study examines changes in utilization patterns and patient characteristics to assess whether such a trend is occurring. METHOD/METHODS:The authors obtained discharge abstract data for all New York City general hospital adult psychiatric patients in 1985 and 1988 as well as utilization data from the public general hospital system for 1977-1989. Three measures of chronicity were chosen: hospital stays longer than 60 days, discharges to long-term care, and three or more admissions per year. Data on psychiatric diagnoses and comorbid diagnoses for chronically ill patients were also reviewed. RESULTS:The mean length of stay of psychiatric patients in general hospitals has increased substantially in recent years and nearly tripled in the public hospitals during 1977-1989. Between 1985 and 1988, citywide increases were due largely to a growing proportion of patients with very long stays. Patients with stays longer than 60 days accounted for 35% of all inpatient days in 1988, compared with 27% in 1985. Patients with chronic illness accounted for half of all days in 1988, compared with 38% in 1985. CONCLUSIONS:Although many factors have contributed to these trends, the leading cause has been reimbursement policies favoring short-term inpatient care. Improving accountability for community treatment programs will be the key to redirecting funding priorities and creating more appropriate alternatives for the chronically mentally ill.

The authors describe New York City's program to remove seriously mentally ill homeless people from the streets to a public hospital. They report on the 298 patients hospitalized during the first year of this program. Most of the patients were male (66%), single (77%), and from outside of New York City (79%) and claimed a history of previous psychiatric hospitalization (92%) and that they had been homeless for more than 1 year (66%). Most of the patients suffered from schizophrenia (80%) and had additional medical diagnoses (73%). Follow-up contact with the patients 2 years after initiation of the program revealed that 55% of the patients either were living in a community setting or were under institutional care

A questionnaire was sent to 244 psychiatrist-administrators from the metropolitan New York City area to assess the actual and perceived effects of five factors--personality traits, clinical psychiatric training, formal training in administration, administrative experience, and a mentor relationship--on their professional development. The results, based on 200 completed questionnaires, revealed a discrepancy between the respondents' actual and ideal experiences in the areas of the mentor relationship and formal administrative training. The authors recommend structural changes in training programs to attract psychiatrists to administrative careers and to enhance their training and professional development

The authors present data showing that the number of mentally ill individuals brought by police officers to psychiatric emergency rooms in New York City increased by 69 percent from 1983 to 1989. They conclude that while the statutory criteria for the involuntary removal of mentally ill persons to hospitals have not changed, case law decisions and public policies that facilitate the involuntary treatment of patients who neglect their essential needs have contributed to this trend. The impact of these visits on hospital based psychiatric emergency room is discussed in terms of increased clinical and legal responsibility for the disposition of persons who are considered dangerous including those who are self-neglectful of their own essential needs

The author describes the functions of the news media and their influence on public mental health policy making. News media functions are divided into the categories of selecting the news, reporting information, serving as a channel of communication, presenting views and opinions, and legitimizing the issues. These functions are illustrated by focusing on a highly publicized New York City policy to involuntarily hospitalize mentally ill homeless people living in the streets. Strategies are suggested to mental health professionals on how to effectively interact with the news media.