Psychiatric Quarterly

, Volume 57, Issue 3–4, pp 230–251 | Cite as

The role of the state hospital: A new mandate for a new era

  • Bert Pepper
  • Hilary Ryglewicz
Articles

Abstract

We are fast approaching a centennial of New York State's institutional system, the anniversary of the State Care Act of 1980. This can be evaluated against another important anniversary; the quarter century mark of the current convulsion/revolution of the mental hygiene care system of the entire United States, commonly referred to as deinstitutionalization.

The state institutions, which for the past century were built up and maintained as the major locus of care for the chronically mentally ill, no longer occupy that central place in many localities. Yet these hospitals must continue to struggle with overwhelming burdens. Their inpatient populations, although now much smaller, still include many seriously mentally ill patients as well as the essentially non-dischargeable elderly.1 In addition, they must provide for young adults with a new profile of difficult behavior and challenging demands.2

This article is an attempt to redefine the role of the state institution in what has become the new era of community care, and to suggest fruitful new directions for the future which incorporate a contemporary shift in focus: from the concept ofillness to that ofdisability, and from a reliance on afacility or specificprogram to the development of a comprehensive and integratedsystem of treatment and support services.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Craig TJ, Laska EM: Deinstitutionalization and the survival of the state hospital.Hospital & Community Psychiatry, 34, July 1983.Google Scholar
  2. 2.
    Weinstein AS, Cohen M: Young chronic patients and changes in the state hospital population.Hospital & Community Psychiatry, 35, June 1984.Google Scholar
  3. 3.
    Wing JK: From Institutional to Community Care.Psychiatric Quarterly, 53, 139–152, 1981.Google Scholar
  4. 4.
    Gruenberg EM, Turns DM, Segal SP et al: Social breakdown syndrome: Environmental and host factors associated with chronicity.American Journal of Public Health, 62, 91–94, 1972.Google Scholar
  5. 5.
    Klein DF: Psychopharmacology: Special considerations. In B. Pepper and H. Ryglewicz (Eds.),The Young Adult Chronic Patient. New Directions for Mental Health Services, No. 14. San Francisco, Jossey-Bass, 1982.Google Scholar
  6. 6.
    Laing RD:The Self and Others. London, Tavistock, 1961.Google Scholar
  7. 7.
    Sullivan HS.Schizophrenia as a Human Process. New York, W.W. Norton, 1962.Google Scholar
  8. 8.
    Szasz TS:The Myth of Mental Illness. New York, Hoeber-Harper, 1967.Google Scholar
  9. 9.
    Bachrach LL: Deinstitutionalization: An analytical review and sociological perspective. Rockville, MD: U.S. Department of Health, Education and Welfare, 1976.Google Scholar
  10. 10.
    Talbott JA: The fate of the public psychiatric system.Hospital & Community Psychiatry, 36(1) January 1985.Google Scholar
  11. 11.
    Hopper K, Baxter E, Cox, S: Not making it crazy: The young homeless patients in New York City. In B. Pepper and H. Ryglewicz (Eds.),The Young Adult Chronic Patient. New Directions for Mental Health Services, No. 14. San Francisco, Jossey-Bass, 1982.Google Scholar
  12. 12.
    Pepper B, Ryglewicz H, Kirshner MC: The uninstitutionalized generation: A new breed of psychiatric patient. In B. Pepper and H. Ryglewicz (Eds.),The Young Adult Chronic Patient. New Directions for Mental Health Services, No. 14. San Francisco, Jossey-Bass, 1982.Google Scholar
  13. 13.
    Bachrach LL: Young adult chronic patients: An analytic review of the literature.Hospital & Community Psychiatry, 33(3) 189–197, March 1982.Google Scholar
  14. 14.
    Morrissey JP, Goldman HH: The alchemy of mental health policy: Homelessness and the fourth cycle of reform.American Journal Public Health, 75:727–731, 1985.Google Scholar
  15. 15.
    Pepper B, Ryglewicz H: Unified services: Concept and practice.Hospital & Community Psychiatry, 33(9) September 1982.Google Scholar
  16. 16.
    Talbott JA: Editor's Notes. In J.A. Talbott (Ed.),Unified Mental Health Systems: Utopia Unrealized. New Directions for Mental Health Services, No. 18. San Francisco, Jossey-Bass, 1983.Google Scholar
  17. 17.
    Berzon P, Lowenstein B: A Flexible Model of Case Management. In B. Pepper and H. Ryglewicz (Eds.),Advances in Treating the Young Adult Chronic Patient. New Directions for Mental Health Services, No. 21. San Francisco, Jossey-Bass, 1984.Google Scholar
  18. 18.
    Stein LI, Test MA: Community treatment of the young adult patient. In B. Pepper and H. Ryglewicz (Eds.),The Young Adult Chronic Patient. New Directions for Mental Health Services, No. 14. San Francisco, Jossey-Bass, 1982.Google Scholar
  19. 19.
    Pepper B: Where (and how) should young adult chronic patients live?: The Concept of a Residential Spectrum.TIE-LINES, Vol. II, No. 2, April 1985. Quarterly bulletin of The Information Exchange on Young Adult Chronic Patients, Inc., New City, NY.Google Scholar
  20. 20.
    Pepper B, Ryglewicz H: The Developmental residence: A ‘missing link’ for young adult chronic patients.TIE-LINES, II(3) July 1985.Google Scholar
  21. 21.
    Lannon PB, Banks SM, Morrissey JP: Update of findings on the statewide CSS population and community tenure data base. Bureau of Evaluation Research, New York State Office of Mental Health, Albany, NY.Google Scholar
  22. 22.
    Sheets JL, Prevost JA, Reihman J: The young adult chronic patient: Three hypothesized subgroups.Hospital & Community Psychiatry, 33(3) 197–202, March 1982.Google Scholar
  23. 23.
    Weinstein AS, Cohen M: Young chronic patients and changes in the state hospital population.Hospital & Community Psychiatry, 35(6) June 1984.Google Scholar
  24. 24.
    Pepper B, Kirshner MC, Ryglewicz H: The young adult chronic patient: Overview of a population.Hospital & Community Psychiatry, 32(7) 463–469, July 1981.Google Scholar
  25. 25.
    Schacter M, Goldberg W: GAP: A treatment approach for the young adult chronic patient. In B. Pepper and H. Ryglewicz (Eds.),The Young Adult Chronic Patient. New Directions for Mental Health Services, No. 14. San Francisco, Jossey-Bass, 1982.Google Scholar
  26. 26.
    Pepper B, Ryglewicz H: Guidelines for treating the young adult chronic patient.TIE-LINES, II,(4) October 1985 and Vol. III, No. 1, January 1986.Google Scholar
  27. 27.
    Carling PJ, Daniels L, Randolph F: A feasibility study to examine the development of a regional community mental health system as an alternative to Vermont State Hospital. Boston University: Center for Psychiatric Rehabilitation, 1985.Google Scholar
  28. 28.
    Joint Hearings, Subcommittee on the Handicapped of the Committee on Labor and Human Resources and the Committee on Labor, Health and Human Services, Education and Related Agencies of the Committee on Appropriations, United States Senate, April 1–3, 1985.Google Scholar
  29. 29.
    Pepper B: The five-year treatment plan: A new tool for contemporary treatment planning. Unpublished.Google Scholar
  30. 30.
    Pepper B: Rockland College Village: A proposal for a new era. Unpublished.Google Scholar

Copyright information

© Human Sciences Press 1985

Authors and Affiliations

  • Bert Pepper
    • 1
    • 2
  • Hilary Ryglewicz
    • 3
  1. 1.the Rockland County Community Mental Health Center in PomonaNew York
  2. 2.Psychiatry at the New York University School of MedicineUSA
  3. 3.the Rockland County Community Mental Health CenterUSA

Personalised recommendations