Objective: In 1988 a governor's commission in Oregon recommended drama
tic changes in the state's approach to public psychiatric hospitalizat
ion. To evaluate the effect of the recommendations, this study examine
d characteristics of hospitalization for patients with schizophrenia a
nd bipolar disorder in public psychiatric facilities between 1981 and
1984 and between 1991 and 1994. Methods: Patients with schizophrenia a
nd bipolar disorder (N=621) were identified as part of a larger study
that examined civil commitment in one of Oregon's state hospitals in 1
986. Data on the patients' hospitalizations were obtained from a state
wide computerized mental health information system, Results: The legal
status of hospitalized patients differed between the two time periods
, with voluntary hospitalizations overrepresented in 1981-1984 and civ
il commitments overrepresented in 1991-1994. The locus of hospitalizat
ion varied greatly between the two time periods. All hospitalizations
in 1981-1984 took place in one of Oregon's three state hospitals, In 1
991-1994, subjects were hospitalized in 13 different institutions, inc
luding state and community hospitals and specially designed nonhospita
l inpatient facilities, Conclusions: Patterns of inpatient hospitaliza
tion for public psychiatric patients changed dramatically from 1981-19
84 to 1991-1994. The extensive use of community and nonhospital facili
ties raises questions about monitoring of quality of care in these div
erse and decentralized facilities.