TRENDS IN PSYCHIATRIC HOSPITAL CARE OF GERIATRIC PATIENTS IN THE UNITED STATES

A bstract : State (or public) mental hospitals in the United States, like many other social institutions, came into being in response to a recognized social need for providing facilities which would offer security for the mentally ill in the population. This review of the history of these hospitals reveals several recurring themes: the tendency for public shifting of the responsibility for the care of the poor and the mentally ill upon the government, and the shifting of this same responsibility between the levels of government (from community to local to state to local community); the periodic rousing of the public interest and compassion by reform movements, too soon followed by public return to apathy or diversion to more rewarding issues; and the recurring conflict between socio‐cultural and scientific values with regard to costs of application of psychotherapeutic methods for care of the patients. Further analysis of the data also reveals that there has been an improvement over time with regard to the physical care of patients, but not in the reduction of their numbers through this care. In fact, until just recently, better care seemed to result only in a greater average duration of hospital stay for many patients, if only because they now lived longer. After rather belatedly becoming concerned about the rising incidence of mental illness in an ever‐increasing population and therefore higher admission rates to already over‐crowded state mental hospitals, the Federal Government authorized a series of studies of the problem, and has passed legislation to begin an alleviation of the situation. Possible outcomes of these legislative measures have been discussed, along with some possibly negative effects if too‐hasty action should be taken in lieu of careful planning.