Objective: National surveys have shown dramatic declines in the number of residents in state psychiatric hospitals since the 1950s and in the number of admissions since the 1970s. However, data from 2002 and 2005 indicate a reversal of these long-term trends. The objective of this study was to present the new data and to advocate for research on the factors contributing to these changes.
Methods: This study is based on state-level data submitted annually to the Center for Mental Health Services. The 11 states showing increases in admissions and residents between 2002 and 2005 were surveyed by telephone about the factors leading to the changes.
Results: Between 2002 and 2005, the number of admissions nationwide increased 21.1%, and the number of residents increased by 1.0%. State mental health agency staff attributed the increases principally to one factor-the increase in the number of forensic admissions and residents. Staff also identified increases in the number of admissions with schizophrenia (increased 23.2%) and affective disorders (increased 16.3%) as a second factor, plus declines in the availability of housing and community-based care providers.
Conclusions: The reversal of long-term trends may signal threats to the goal of community-based mental health care. Research is urgently needed to examine the factors associated with these increases. Potential factors to be investigated include the increase in the number of forensic admissions and the antecedents of this phenomenon, increases in the number of admissions with schizophrenia, the changing capacity of general hospital inpatient psychiatric services in the community, and changes in the demographic makeup of American society, reflected in an aging population and increased racial-ethnic diversity.