Administration in mental health

, Volume 15, Issue 3, pp 139–156 | Cite as

Community mental health systems generate new chronics: The study of a pure case

  • Harvey J. Lieberman
  • Judith Nigro
  • Patricia Trembath
  • Dolores H. Tenczynski
  • Doris Dlugacz
  • Steven Scher


This study indicates that while a well-integrated comprehensive community mental health system (CMHS) can dramatically reduce the utilization of long-stay inpatient beds compared to more traditional care systems, it does not banish the appearance of “new chronic” patients from a catchment area. South Beach Psychiatric Center, the CMHS which is the focus of this study, is a state-operated program with a New York City location that provides all long-stay hospital beds and the major proportion of acute inpatient and community care for the 1.36 million people in its service delivery region. Compared to the patient population of traditional care systems, CMHS new chronic patients are younger, composed of more males, have a higher percentage of schizophrenia diagnoses, and show fewer signs of institutionalization. In addition, CMHS patients frequently exhibit dangerous behaviors. Major elements of CMHS operations contributing to these findings, particularly the small number of available long-stay beds, are reviewed. Recommendations are made for community-oriented system design.


Schizophrenia Service Delivery Catchment Area York City Community Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anthony, W.A., Kennard, W.A., O'Brien, W.F., & Forbess, R. (1986). Psychiatric rehabilitation: Post myths and current realities.Community Mental Health Journal, 22(4), 249–264.Google Scholar
  2. Bachrach, L. (1981). Discussion: The role of model programs in the care of chronic mental patients. In J.A. Talbott (Ed.),The chronic mentally ill (pp. 300–314). New York: Human Sciences Press.Google Scholar
  3. Caton, C.L.M. (1984)Management of chronic schizophrenia. New York: Oxford University Press.Google Scholar
  4. Craig, T.T., Goodman, A.B., Siegel, C., & Wanderling, J. (1984). The dynamics of hospitalization in a defined population during deinstitutionalization.American Journal of Psychiatry, 141 782–785.Google Scholar
  5. Craig, T.T., & Laska, T.M. (1983). Deinstitutionalization and the survival of the state hospital.Hospital & Community Psychiatry, 34 616–622.Google Scholar
  6. DeRisi, W., & Vega, W.A. (1983). The impact of deinstitutionalization in California's state hospital population.Hospital & Community Psychiatry, 34(2), 140–145.Google Scholar
  7. Goodman, A.B., & Siegel, C. (1986). Elderly schizophrenic inpatients in the wake of deinstitutionalization.American Journal of Psychiatry, 143 204–207.Google Scholar
  8. Holcomb, W.R., & Ahr, P.R. (1986). Clinicians' assessments of the service needs of young adult patients in public mental health care.Hospital & Community Psychiatry, 37(9), 908–912.Google Scholar
  9. Kiesler, C.A. (1982). Mental hospitals and alternative care: Noninstitutionalization as potential public policy for mental patients.American Psychologist, 37 349–360.Google Scholar
  10. Levene, L.S., Donaldson, L.J., & Brandon, S. (1985). How likely is it that a district health authority can close its large mental hospitals.British Journal of Psychiatry, 147 150–155.Google Scholar
  11. Lieberman, H.J., Campanelli, P.C., Hahn, D., Gordon, A., Tabot, A., Sacks, J., & Weston, R. (1985). The Community Residential Treatment Service: Developing a continuum of prosthetic environments for the chronically disabled.Journal of Community Psychology, 13 46–53.Google Scholar
  12. Lipton, A., & Simon, F. (1985). Psychiatric diagnosis in a state hospital: Manhattan State revisited.Hospital & Community Psychiatry, 36(4, 368–373.Google Scholar
  13. McCreadie, R.G., Oliver, A., Wilson, A., & Burton, L.L. (1983). The Scottish survey of new chronic inpatients.British Journal of Psychiatry, 143 564–571.Google Scholar
  14. Morissey, J.P. & Goldman, H.H. (1984). Cycles of reform in the case of the chronically mentally ill.Hospital & Community Psychiatry, 35 785–793.Google Scholar
  15. Pepper, B., & Ryglewicz, H. (Eds.). (1982).New directions for mental health services: The young adult chronic patient. San Francisco: Jossey Bass.Google Scholar
  16. Platman, S.R., Karahasan, A., & Booker, T.C. (1983). The new long-term patient in the public mental hospital.American Journal of Psychiatry, 140 5.Google Scholar
  17. Staff. (1983). Gold award: A center's integrated service system for chronic patients.Hospital & Community Psychiatry, 34 954–957.Google Scholar
  18. Talbott, J.A. (Ed.). (1981).The chronic mentally ill. New York: Human Science Press.Google Scholar
  19. Talbott, J.A. (1983). The fate of the public psychiatric system.Hospital & Community Psychiatry, 35 46–50.Google Scholar
  20. Taube, C.A., Thompson, J.W., Rosenstein, M.J., Rosen, B.M., & Goldman, H.H. (1983). The chronic mental hospital patient.Hospital & Community Psychiatry, 34(7), 611–615.Google Scholar
  21. Way, B.B. (1983).Guide to the level of care statistical reports. Unpublished, New York State Office of Mental Health, Bureau of Program Evaluation.Google Scholar

Copyright information

© Human Sciences Press 1988

Authors and Affiliations

  • Harvey J. Lieberman
  • Judith Nigro
  • Patricia Trembath
  • Dolores H. Tenczynski
  • Doris Dlugacz
  • Steven Scher

There are no affiliations available

Personalised recommendations