Community Mental Health Journal

, Volume 29, Issue 2, pp 103–114

The politics of closing state mental hospitals: A case of increasing policy gridlock

  • Fred W. Becker
Articles

Abstract

There are political and administrative barriers to closure of the remaining state mental hospitals. Some of these barriers owe their existence to the current lack of community-based alternatives for the care and treatment of the severely mentally ill. In addition, uncertainty of the future funding and regulatory commitment of state governments to community programs contributes to an unwillingness by influential groups to recommend or implement closure. Finally, other barriers include rigid budgetary processes, the self-interest of public employees., and the lack of consensus in the decision making process.

The result is that even when the case for closure of a state mental hospital is convincing, these political and administrative factors can cause “policy gridlock.”. This article describes how such policy gridlock occurs and offers several suggestions as to how it can be prevented.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Anthony, W.A., Cohen, M., Farkas, M., & Cohen, B.F. (1988). Clinical care update: The chronically mentally ill.Community Mental Health Journal, 24, 219–228.Google Scholar
  2. Becker, F.W. (1992). Contracting for the involuntary treatment of the mentally ill: Legislative attitudes.Administration and Policy in Mental Health, 19(4): 321–333.Google Scholar
  3. Bond, G., Miller, L.D., Krumwied, R.D., & Ward, R.S. (1988). Assertive case management in three CMHCs: A controlled study.Hospital and Community Psychiatry., 39, 411–418.Google Scholar
  4. Cutler, D.L. (1986). Community care options for the chronically mentally ill.Community Mental Health Journal, 22, 61–73.Google Scholar
  5. Dickey, B. & Goldman, H.H. (1986). Public health care for the chronically mentally ill: Financing operating costs.Administration in Mental Health, 2, 63–71.Google Scholar
  6. Dorwart, R.A., Epstein, S., & Davidson, H. (1988). The shifting balance of public and private inpatient services: Implications for administrators.Administration and Policy in Mental Health, 16, 4–13.Google Scholar
  7. Feis, C.L., Mowbray, C.T., & Chamberlain, P.J. (1990). Serving the chronic mentally ill in state and community hospitals.Community Mental Health Journal, 26, 221–232.Google Scholar
  8. Florida Council for Community Mental Health (FCCMH). (1991).Right-sizing state institutions. Tallahassee, FL: FCCMH. Mimeographed.Google Scholar
  9. Florida Department of Health and Rehabilitative Services (HRS). (1989).A study of mentally ill persons residing in adult congregate living facilities. Tallahassee, FL: HRS. Mimeographed.Google Scholar
  10. —. (1991). South Florida State Hospital briefing package. Tallahassee, FL: HRS. Mimeographed.Google Scholar
  11. Franklin, J.L., Solovitz, B., Mason, M., Clemons, J.R., & Miller, G. (1987). An evaluation of case management.A merican Journal of Public Health, 77, 674–678.Google Scholar
  12. Glazer, S. (1987). Unfulfilled promises to the mentally ill.Congressional Quarterly's Editorial Research Reports, 1(6), 66–75.Google Scholar
  13. Goering, P.N., Wasylenki, D.A., Farkas, M., Lancee, W.J., & Ballantyne, R. (1987). What difference does case management make.Hospital and Community Psychiatry, 39, 272–276.Google Scholar
  14. Kiesler, C.A. & Sibulkin, A.A. (1987).Mental hospitalization: Myths and facts about a national crisis Newbury Park, CA: Sage.Google Scholar
  15. Langer, M., & Marshall, P.E. (1988). New direction for treating the chronically mentally ill in New York State.Administration and Policy in Mental Health, 16, 107–110.Google Scholar
  16. Lyall, S. (1992). Psychiatric hospitals facing big cuts.New York Times, January 30.Google Scholar
  17. Peters, R., Miller, K.S., Schmidt, W. & Meeters, D. (1987). The effects of statutory change on the civil commitment of the mentally ill.Law and Human Behavior, 2, 73–99.Google Scholar
  18. Rogers, P. (1992). Life less bleak at state hospital, but, care still called poor.Miami Herald, March 8, p. 6B.Google Scholar
  19. Santiago, J.M. (1987). Reforming a system of care: The Arizona experiment.Hospital and Community Psychiatry, 38, 270–273.Google Scholar
  20. Shulberg, H.C. & Manderscheid, R.W. (1989). The changing network of mental health service delivery. In, C.A. Taube, D. Mechanic, & A.A. Hohmann (Ed.),The future of mental health services research, (pp. 11–22). Washington, DC: U.S. Government Printing, Office.Google Scholar
  21. Smith, S. (1990a). Hopes high for psychiatric bed additions.Miami Herald, May 20, p. 1BR.Google Scholar
  22. Smith, S. (1990b). State hears debate on quest for more mental ward beds.Miami Herald, June 1, p. 6BR.Google Scholar
  23. Taube, C.A., & Goldman, H.H. (1989). State strategies to restructure psychiatric hospitals: A selective review.Inquiry, 26, 146–156.Google Scholar
  24. Test, M.A., & Stein, L. (1980). Alternatives to mental hospital treatment.Archives of General Psychiatry, 37, 409–412.Google Scholar
  25. Torrey, E.F., Wolfe, S.M., & L.M. Flynn. (1990).Care of the seriously mentally ill: A rating of state programs. Third edition. Washington., DC: Health Research Group.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1993

Authors and Affiliations

  • Fred W. Becker
    • 1
  1. 1.Department of Health Services AdministrationFlorida International UniversityN. Miami

Personalised recommendations