Serious mental illness: Characteristics of state hospital organizational structures supportive of rehabilitation and recovery

There has been a consistent effort to move treatment and support for persons with severe and disabling psychiatric disabilities into community-based settings and the rate of movement from institutions to community-based settings varies as a function of the current political climate and monies allocated for mental health care. With relatively recent advances in community-based rehabilitation and the reallocation of public funds away from inpatient treatment, law makers, administrators, and others continue to ask why all clients cannot be treated in the community. The reason is that there are subgroups of people with severe mental illness who continue to require the supports, protection, and restrictiveness of a state hospital. The purpose of this study is to identify and analyze factors associated with reform and modernization of mental health services, specifically services for people with severe and disabling mental illness needing treatment in secure settings for extended periods of time. The analyses in this study first address two general questions about state hospitals: (1) what is the appropriate role of the modern state hospital, and (2) what administrative and organizational factors encourage and what factors inhibit performance of that role? The analysis then continues with a case study that permits some empirical evaluation of the operation of administrative and policy factors. The case is the Psychiatric Rehabilitation Program, a psychiatric rehabilitation program housed in a state psychiatric hospital. The circumstances of the case study permit evaluation of one key principle suggested by the historical analysis: whether psychiatric rehabilitation can be implemented within a traditional centralized institutional organizational and administrative framework. The case study failed to support the hypothesis that psychiatric rehabilitation could operate in a traditional centralized hospital/institutional organizational and administrative framework