Hospital & community psychiatry
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Without reform and linkage to unified care system, state hospitals may become overcrowded and underfunded during the coming decades. The author delineates ten epidemiologic, demographic, and systemic factors that point to increases in episodes of chronic illness which are most likely to end in state hospitalization. General hospitals, nursing homes, and community-based programs are compared as possible substitutes for state hospitals. Finally the author recommends twelve internal reforms to strengthen the state hospital system as an integral part of the chronic care network.
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Determining the number of beds a community needs for the treatment of psychiatric patients has long been a concern of health planners. Variations in the definition of what constitutes a "bed" and in the mental health systems, environmental and social factors, financial considerations, and planning techniques found in each community all have contributed to making resource planning a difficult and highly localized task. The authors discuss these and other issues that planners must take into account in arriving at an estimated number of beds for psychiatric treatment, and point to the planning efforts of California, Nebraska, and Great Britain as three comprehensive approaches. They caution that there are no definitive answers to the questions posed by resource planning and encourage efforts to better classify resources, to provide more information on service systems, and to first design comprehensive community services before eliminating acute inpatient care beds.