Long-stay patients in state psychiatric hospitals at the end of the 20th century

Objectives: The purpose of this study was to assess the characteristics of long-stay patients in contemporary state psychiatric hospitals and to ident ify, factors representing possible barriers to alternative placements for t hese patients. Methods: All patients in inpatient units of the Massachusett s Department of Mental Health who had been hospitalized for at least three years as of April 1, 1999, were assessed by their treatment teams with a st andardized data collection instrument. Domains assessed included medical pr oblems, need for nursing care, psychiatric diagnosis, and history of proble matic behaviors. Results: The 330 individuals identified as long-stay patie nts had an array of medical problems and nursing care needs that likely wou ld have been manageable in other long-term-care settings. A total of 276 pa tients had at least one significant medical problem. However, some patients exhibited behavioral problems that might have complicated such placements, especially when behavioral problems co-occurred with the need for medical supervision. A total of 228 patients had exhibited a significant problemati c behavior in the previous 30 days. Conclusions: Although the number of lon g-stay patients in state psychiatric hospitals declined dramatically during the second half of the 20th century, a small group of patients still requi res care in this setting. State psychiatric hospitals continue to occupy a significant niche in the mental health system.