The shifting balance of public and private inpatient psychiatric services: Implications for administrators

  • Robert A. Dorwart
  • Sherrie Epstein
  • Harriet Davidson


Privatization of mental health care is a major trend in the delivery of mental health services. Besides the marked expansion of private and proprietary facilities there are more complex mechanisms at work, such as conversion from public to private auspices, substitution of private for public inpatient capacity, and overlapping of services between the two sectors. Administrators feel pressure to adopt “business-like” approaches as nonprofit institutions emulate for-profit ones. These influences are described, including increasing marketing, advertising, subspecialization and competitive strategies. The authors suggest that it remains a challenge for administrators to maintain those goals and outcomes most consistent with the mission of the institutions in which they work.


Public Health Health Care Mental Health Health Service Mental Health Service 


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  1. Chodoff, P. (1987). Economic climate and psychotherapeutic practice.American Journal of Psychiatry, 144(10), 1293–1297.Google Scholar
  2. Dorwart, R. (1988). A ten-year follow-up of the effects of deinstitutionalization.Hospital and Community Psychiatry, 39, (3), 287–291.Google Scholar
  3. Dorwart, R.A. & Schlesinger, M. (1988). Privatization of psychiatric services.American Journal of Psychiatry, 145(5).Google Scholar
  4. Dorwart, R.A., Schlesinger, M., Horgan, C., & Davidson, H. (1988). The privatization of mental health care and directions for mental health services research.Health Services Research. NIMH, in press.Google Scholar
  5. Freedman, R.I. & Moran, A.M. (1984). Wanderers in a promised land: The Chronically Mentally Ill and Deinstitutionalization.Medical Care, Supplement 22, s1–60.Google Scholar
  6. Goldman, H. (1987). The Future Environment of Psychiatry: Background Statement. Paper at the American Psychiatric Association Conference on the Future of Psychiatry, Alexandria, Virginia, December 1, 1987.Google Scholar
  7. Greene, J. (1987). Competition spurs collaboration among Catholic systems.Modern Healthcare, 17, 11.Google Scholar
  8. Hillman, A.L., Nash, D.B., Kissick, W.L., & Martin, S.P.: Sounding board: Managing the medical-industrial complex.New England Journal of Medicine,315(8), 511–13.Google Scholar
  9. Iglehart, J.K. (1986). Health policy report: Canada's health care system.New England Journal of Medicine, 315(3), 202–208.Google Scholar
  10. Kennedy, L. (1985). The proprietarization of voluntary hospitals.Bulletin of the New York Academy of Medicine, 61(1). 81–89.Google Scholar
  11. Levey, S. & Hess, D.D. (1985). Sounding board: Bottom-line health care?New England Journal of Medicine, 312(10), 644–647.Google Scholar
  12. Mandersheid, R.W. & Barrett, S.A. (Eds.). (1987). Mental Health United States, National Institute of Mental Health. DHHS Pub. No. (ADM)87-1518. Washington, D.C.: Supt. of Docs., U.S. Govt. Printing Office.Google Scholar
  13. Marmor, T.R., Schlesinger, M. & Smithey, R.W. (1986). A new look at nonprofits: Health care policy in a competitive age.Yale Journal on Regulation, 3, 313–349.Google Scholar
  14. Mechanic, D. (1987). Correcting misconceptions in mental health.Milbank Memorial Fund Quarterly, 65(2), 203–230.Google Scholar
  15. Modern Healthcare. Editorial, July 1987, 7.Google Scholar
  16. Morrissey, J.P., Witkin, M.J. & Bethel, H.E. (1986). Trends by State in the Capacity and Volume of Inpatient Services, State and County Mental Hospitals, United States, 1976–1980. National Institute of Mental Health Series CN No. 10. DHHS Pub. No. (ADM)86-1460. Washington; Superintendent of Documents, U.S. Government Printing Office.Google Scholar
  17. Schlesinger, M. & Dorwarr, R. (1984). Ownership and Mental Health Services.New England Journal of Medicine, 311, (14), 959–965.Google Scholar
  18. Sharfstein, S.S. & Beigel, A. (1985).The new economics and psychiatric care. Washington, D.C.: American Psychiatric Press.Google Scholar
  19. Shore, M.F. & Levinson, H. (1983). On business and medicine.New England Journal of Medicine, 313, 5, 319–321.Google Scholar
  20. Starr, P. (1982). The social transformation of American medicine. New York: Basic Books, Inc.Google Scholar
  21. Stevens, B. (1987). Review essay: for-profit medicine.Journal of Health Politics, Policy and Law, 12(3), 569–580.Google Scholar
  22. Wright, R.A. & Allen, B.H. (1983). Marketing and medicine.Journal of the American Medical Association, 250(1), 47.Google Scholar

Copyright information

© Human Sciences Press 1988

Authors and Affiliations

  • Robert A. Dorwart
    • 1
  • Sherrie Epstein
    • 2
  • Harriet Davidson
  1. 1.Cambridge Hospital Department of PsychiatryCambridgeUSA
  2. 2.Harvard Business School and the J.F.K. School of GovernmentCambridgeUSA

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