title: Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix.
abstract: A 1978 consent decree affecting one region of Massachusetts mandated a drastic reduction of census at its state hospital, where considerable deinstitutionalization had already occurred over the prior two decades. The transfer of patients from hospital to community was to be accomplished through the unprecedented expansion of community resources. This second-generation deinstitutionalization effort achieved substantial census reduction but less than was envisioned. It was most effective in discharging geriatric and mentally retarded patients but far less effective with longterm and new chronic patients, many of whom continue to require repeated hospitalizations despite the availability of a comprehensive array of community-based services.
authors.affiliation: Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655.
authors.forename: J L
authors.initials: JL
authors.lastname: Geller
authors.forename: W H
authors.initials: WH
authors.lastname: Fisher
authors.forename: J L
authors.initials: JL
authors.lastname: Wirth-Cauchon
authors.forename: L J
authors.initials: LJ
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution; D003365:Costs and Cost Analysis; D003688:Deinstitutionalization / Q000331:legislation & jurisprudence*; D003953:Diagnosis-Related Groups / Q000331:legislation & jurisprudence*; D006778:Hospitals, Psychiatric / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008404:Massachusetts; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D010344:Patient Advocacy / Q000331:legislation & jurisprudence