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Dominic Sisti, Andrea Segal, and Ezekiel Emanuel

Improving Long-term Psychiatric Care: Bring Back the Asylum

JAMA, January 2015
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Abstract

During the past half century, the supply of inpatient psychiatric beds in the United States has largely vanished. In 1955, 560,000 patients were cared for instate psychiatric facilities; today there are fewer than one-tenth that number: 45,000. Given the doubling of the US population, this represents a 95% decline, bringing the per capita public psychiatric bed count to about the same as it was in 1850—14 per 100,000people. A much smaller number of private psychiatric beds has fluctuated since the 1970s in response to policy and regulatory shifts that create varying financial incentives. 

As a result, few high-quality, accessible long-term care options are available for a significant segment of the approximately 10 million US residents with serious mental illness. This population includes adults who are assessed as lacking insight and chronically psychotic, unable to care for themselves, and potentially dangerous to themselves and the public. These persons frequently have refractory schizophrenia and bipolar disorder. The void is both ethically unacceptable and financially costly.

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