The infusion of ideology has produced a somewhat polarized configuration of beliefs and perspectives, despite the polythetic convolutions and vicissitudes of more scientific and technological considerations. At one pole, there is the view that clinical technology now provides a complete alternative to state hospitals, that we no longer need them, that they cause more problems than they solve. At the other pole is the view that abandonment of state hospitals is abandonment of at least some people within the larger population of those with severe and disabling psychiatric disorders. Parties at both poles and at all points between express paramount concern for the safety, comfort, and humanity of the subject population. However, at times they may be concerned about different subject populations.
Emotions sometimes run high.
This issue of New Directions for Mental Health Services is a collection of chapters that address various aspects of the debate about the future of state hospitals. The editor makes no claim to have purged the content of ideological perspectives. Indeed, health care policy must ultimately be a synthesis of scientific, philosophical, technological, economic, political, and therefore ideological considerations. However, none of the chapters in this collection can be assigned to one or another of the aforementioned poles. They all convey a modicum of caution, even skepticism, about the notion that there is no longer a need for state hospital based services, now or in the foreseeable future.