CHANGES IN PUBLIC PSYCHIATRIC-HOSPITALIZATION IN OREGON OVER THE PAST2 DECADES

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.