Using data from the National Hospital Discharge Survey and the Inventory of Mental Health Organizations, this article examines national trends in psychiatric inpatient care from 1988 to 1994 in general hospitals and mental hospitals. We find that discharges with a primary diagnosis of mental illness in general hospitals increased from 1.4 to 1.9 million during this period. The total increase of 1.2 million days of care in general hospitals was small relative to the reduction of 12.5 million inpatient days in mental hospitals. General hospital discharges increased most in private nonprofit hospitals and declined substantially in public hospitals. Length of stay has fallen most substantially in private nonprofit hospitals. Public programs have increasingly replaced private insurance as the major source of payment. These observations suggest that psychiatric inpatient care in general hospitals can be characterized as a process in which patients who would have been clients of public mental hospitals in a prior period replace privately insured patients who, under managed care, are largely treated in community settings. Private nonprofit general hospitals increasingly treat publicly financed patients with more severe illnesses.
Average length of stay in general hospitals for psychiatric discharges by hospital ownership. Lengths of stay of less than 1 day are recoded to equal 1 day. Means (approximate SEs) are presented.
Percentage of psychiatric discharges to the community after hospitalization of 5 days or less by hospital ownership. Analysis included only discharges to the community (routine or against medical advice). Percentages (approximate SEs) are presented. Superscripts denote significant differences (P≤.05) between groups: a, different from public; b, different from private nonprofit; and c, different from proprietary. Asterisk indicates relative SE of the numerator greater than 10% (<12.5%).
Total psychiatric days of care (in millions) in general hospitals by hospital ownership. Total days (approximate SEs) are presented. Superscripts denote significant differences (P≤.05) between groups: a, different from public; b, different from private nonprofit; and c, different from proprietary.
Percentage of psychiatric discharges transferred by hospital ownership. Discharge status was missing for 3.3% of discharges in 1988, 4.9% in 1990, 4.7% in 1992, and 6.5% in 1994. Percentages (approximate SEs) are presented. Superscripts denote significant (P≤.05) differences between groups: a, different from public; b, different from private nonprofit; and c, different from proprietary. Asterisk indicates relative SE of the numerator greater than 10% (<20.0%).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Psychiatry editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 76
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.