Dual Diagnosis: Examination of Service Use and Length of Stay During Psychiatric Hospitalization

  • Steven P. Lohrer
  • Elliot Greene
  • Charles J. Browning
  • Michael S. Lesser


Anecdotal reports suggest that persons with a dual diagnosis (mental retardation and psychiatric illness) admitted to acute psychiatric hospitals stay longer and require more services than individuals without mental retardation. To test these hypotheses, a questionnaire was completed for 64 people with dual diagnosis admitted to 10 psychiatric hospitals over 3 months. Multivariate analysis revealed that a diagnosis of mental retardation was not a predictor of length of stay. Use of 1-to-1 staffing was more likely, while arrangement of different community placement at discharge was less likely for persons with than without dual diagnosis. Additionally, age, diagnosis, symtomatology, living arrangement, insurance status, and service use distinguished the patient groups. Implications are discussed in the context of a need for further examination and training focused toward this population.

mental retardation psychiatric disorder psychiatric treatment inpatient hospitalization dual diagnosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Addington, D., Addington, J., and Ens, I. (1993). Mentally retarded patients on general hospital psychiatric units. Can. J. Psychiatry 38: 134–136.Google Scholar
  2. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn., American Psychiatric Association, Washington, DC.Google Scholar
  3. Beasley, J., Kroll, J., and Sovner, R. (1992). Community-based crisis mental health services for person with developmental disabilities: The S.T.A.R.T. model. Habilitative Ment. Health Newsl. 11: 55–57.Google Scholar
  4. Borenstein, M., and Cohen, J. (1988). StatisticalPower Analysis:AComputer Program, Erlbaum, Hillsdale, NJ.Google Scholar
  5. Borthwick-Duffy, S. (1994). Epidemiology and prevalence of psychopathology in persons with mental retardation. J. Consult. Clin. Psychol. 62: 17–27.Google Scholar
  6. Borthwick-Dufy, S., and Eyman, R. (1990). Who are the dually diagnosed? Am. J. Ment. Retard. 94: 586–595.Google Scholar
  7. Bruininks, R., Hill, B., and Morreau, L. (1988). Prevalence and implications of maladaptive behaviors and dual diagnosis in residential and other service programs. In Stark, J., Menolacino, F., Albarelli, M., and Gray, V. (eds.), Mental Retardation and Mental Health: Classification Diagnosis, Treatment Services, Springer, New York, pp. 3–29.Google Scholar
  8. Cohen, J. (1987). Statistical Power Analysis for the Behavioral Sciences, Rev. edn., Erlbaum, Hillsdale, NJ.Google Scholar
  9. Crews, W., Bonventura, S., and Rowe, F. (1994). Dual diagnosis: Prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation. Am. J. Ment. Retard. 98: 724–731.Google Scholar
  10. Davidson, P., Cain, N., Sloane-Reeves, J., Giesow, V., Quijano, L., Van Heyningen, J., and Shoham, I. (1995). Crisis intervention for community-based individuals with developmental disabilities and behavioral and psychiatric disorders. Ment. Retard. 33: 21–30.Google Scholar
  11. Davidson, P., Cain, N., Sloane-Reeves, J., Van Speybroech, A., Segel, J., Gutkin, J., Quijano, L., Kamer, M., Shoham, I., and Goldstein, E. (1994). Characteristics of community-based individuals with mental retardation and aggressive behavioral disorders. Am. J. Ment. Retard. 98: 704–716.Google Scholar
  12. Edelstein, T., and Glenwick, D. (1997). Referral reasons for psychological services for adults with mental retardation. Res. Dev. Disabil. 18: 45–59.Google Scholar
  13. Jacobson, J. (1982). Problem behavior and psychiatric impairment within a developmentally disabled population. I: Behavior frequency. Appl. Res. Ment. Retard. 3: 121–139. 158 Lohrer, Greene, Browning, and Lesser Google Scholar
  14. Menolascino, F., and Fleisher, M. (1993). Mental health care in persons with mental retardation: Past, present, and future. In Fletcher, R., and Dosen, A. (eds.), Mental Health Aspects of Mental Retardation, Lexington Books, New York, pp. 18–41.Google Scholar
  15. Menolascino, F., Gilson, S., and Levitas, A. (1986). Issues and treatment of mentally retarded patients in the community mental health system. Community Ment. Health J. 22: 314–327.Google Scholar
  16. New York State Department of Health (1997). Statewide Planning and Research Cooperative System (SPARCS), New York State Department of Health, Albany.Google Scholar
  17. Nezu, C. M., Nezu, A. M., and Gill-Weiss, M. (1992). Psychopathology inPersonWith Mental Retardation: Clinical Guidelines for Assessment and Treatment, Research Press, Champaign, IL.Google Scholar
  18. Overall, J., and Gorhan, D. (1962). Brief psychiatric rating scale. Psychol. Rep. 10: 799–812.Google Scholar
  19. Petronko, M., Harris, S., and Kormann, R. (1994). Community-based behavioral training approaches for people with mental retardation and mental illness. J. Consult. Clin. Psychol. 62: 49–54.Google Scholar
  20. Pfadt, A. (1997). Community-base service update: Models for service delivery. Habilitative Ment. Health Newsl. 16: 26–28.Google Scholar
  21. Reiss, S. (1990). Prevalence of dual diagnosis in community-based day programs in the Chicago metropolitan area. Am. J. Ment. Retard. 94: 578–585.Google Scholar
  22. Reiss, S. (1994). Handbook of Challenging Behavior: Mental Health Aspects of Mental Retardation, IDS, Worthington, OH.Google Scholar
  23. Rothstein, H., Borenstein, M., Cohen, J., and Pollack, S. (1990). Statistical power analysis for multiple regression/correlation: A computer program. Educ. Psychol. Meas. 50: 819–830.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Steven P. Lohrer
    • 1
  • Elliot Greene
    • 2
  • Charles J. Browning
    • 2
  • Michael S. Lesser
    • 2
  1. 1.School of Social WorkColumbia UniversityNew York
  2. 2.New York City Department of Mental HealthMental Retardation, and Alcoholism ServicesNew York

Personalised recommendations