OLDER PATIENTS IN UNITED STATES PUBLIC MENTAL HOSPITALS: A NATIONAL SURVEY OF ADMINISTRATIVE OPINIONS

A survey of the psychiatric literature reveals that a number of confusions and conflicts exist among psychiatrists and other professional personnel with regard to the efficacious management of elderly mentally ill patients. This study was an attempt to throw some light on the subject by obtaining from 50 state official mental hygiene agencies and the administrators of 269 public mental hospitals their estimates of the dimensions of the geriatric psychiatric problem in their respective states, and of the prevailing therapeutic climate for the mentally ill aged in their hospitals. This was done by means of a two-section questionnaire. Responses were received from 48 agencies and 216 hospitals, but only those from 43 agencies and 178 hospitals were in usable form. The following is a summary of the findings: There was substantial agreement between official mental hygiene agencies and hospital administrators with respect to the size of the geriatric populations in public mental hospitals in the various states. When there was a disagreement, it could be attributed to factors such as inadequacy of official or state records and/or poor communication between official agencies and their system hospitals. Perhaps as a consequence of being closer to the actual care of patients, hospital administrators tended to be less optimistic than mental hygiene agencies about the number of unnecessary admissions, the possible benefits of therapy, and the conceivable hospital discharge rates for patients in the older age groups. Regarding the therapeutic climate, only two items elicited nearly unanimous responses among the mental hygiene agencies and within their states: 1) the importance of adequate diagnosis in the management of older patients, and 2) the undesirability of long-term therapy programs for them. All other “climate” items elicited a wide divergence of opinions. For example, respondents in both groups were about evenly divided concerning their views about rehabilitation potential, and the cooperativeness in therapeutic activities among geriatric patients. Based upon the survey of comments from both respondent groups, it is concluded that: Currently there is emphasis upon rehabilitation programs for older mental patients in some state hospitals (probably a minority), with gratifying results. Both old and new concepts of mental illness and its therapeutic management in elderly patients may exist side by side within the same hospital system, leading to inconsistencies and inefficiencies in the total state rehabilitation program. There is great variability in the existence and the expected usefulness of community facilities and resources across the country. When the state hospitals have assumed the mantle of leadership, guidance and support of community facilities, a large number of aged patients have been successfully discharged and adequately cared for. Hospital emphasis upon and official agency support of geriatric screening programs have resulted not only in a reduction in the number of admissions to state mental hospitals through more proper placement in nursing homes and other community facilities, but also in the return of many adequately functioning elderly patients to their own community homes.