Hospital & community psychiatry最新文献

Objective: Total monetized and nonmonetized costs and benefits to society of the Monroe-Livingston demonstration project's capitated payment system (CPS) were analyzed.

Methods: Total costs and benefits of care for individuals who were prerandomized to an experimental group (of whom about 57 percent were enrolled in the CPS) were compared with those for a control group who received traditional fee-for-service care. Separate two-year results are presented for continuous patients, who were enrolled in a comprehensive CPS plan (N = 201) and for intermittent patients, who were enrolled in a partial plan (N = 155).

Results: All groups showed improvements on many psychosocial measures over the two years. Continuous patients in the experimental group experienced less hospitalization, more case management and transportation services, and higher levels of victimization and were more likely to live in unsupervised settings than continuous patients in the control group. Total annual per patient costs for care of continuous patients ranged from $74,000 to more than $100,000, largely reflecting differences in rates of hospitalization. Experimental subjects in the partial capitation condition differed from the control group in this plan on fewer measures; both groups reported high levels of case management and social support services and relatively lower levels of supervised housing.

Conclusions: The CPS resulted in major improvements in the community's services for persons with serious mental illness and reduced the proportion of care provided in the state hospital.

Objectives: The authors sought information on the number, structure, and effectiveness of programs aimed at diverting mentally ill inmates from the criminal justice system into the mental health treatment system.

Methods: A working definition of a jail diversion program was developed. Mail surveys were distributed to 1,263 U.S. jails with a capacity of 50 or more detainees to ascertain the presence or absence of diversion programs. Telephone interviews with samples of respondents and nonrespondents to the mail survey yielded additional information about the programs' operation, funding, staffing, and directors' perceptions of their effectiveness.

Results: Information obtained from the mail and telephone surveys indicated that only 52 U.S. jails with a capacity of 50 or more detainees had formal mental health diversion programs that fit the definition developed by the authors. Programs in larger jails served fewer violent felons than did those in smaller jails. Three-fourths of the programs were located in mental health agencies. Two-thirds of program directors considered the programs to be moderately or very effective.

Conclusions: Only a small number of U.S. jails have diversion programs for mentally ill detainees, and objective data on their effectiveness are lacking. Systematic evaluations are needed to determine what types of programs work best for which types of detainees.

Objective: The authors examined important trends and developments within the mental health field since the 1960s as reflected in articles published in Hospital and Community Psychiatry.

Methods: A total of 798 articles were reviewed, representing all contributions to the journal in 1962, 1967, 1972, 1977, 1982, 1987, and 1992. Articles were classified into one of six categories, and empirical research articles were further classified by primary topic. In addition, all articles were indexed by primary setting (hospital, community, or both); academic credentials and gender of first author, and economic or public policy focus.

Results: The number and percentage of empirical research articles increased over time, while articles describing programs and professional roles declined. Some changes were observed in the primary topics of empirical research. Other findings reflect a shift in the setting of articles from hospitals to the community and a growth in the percentage of women who were first authors and of authors with a Ph.D. degree.

Conclusions: The documented growth of empirical research in psychiatry suggests a greater emphasis on methodological rigor in the design and implementation of mental health services. Moreover, increases noted in scholarly contributions by women and nonmedical professionals indicate a broadening of disciplinary perspective over time that is likely to strengthen psychiatric research and services.