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December 9, 1983

Whither goes in/outpatient psychiatric care?

JAMA. 1983;250(22):3018-3019. doi:10.1001/jama.1983.03340220004002

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"Anyone reading newspapers in the United States knows that there are many former state mental hospital patients living and sleeping on the streets or in dilapidated hotels."

With these words, Alfred M. Freedman, MD, chair of the Department of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, NY, engaged in a discourse at the recent Seventh World Congress of Psychiatry in Vienna on the pluses and minuses of the well-known shift from government (state) hospitals to general hospitals as the principal site of inpatient psychiatric care in the United States.

According to Freedman, 75% of psychiatric patients received treatment in state hospitals in 1955 and occupied approximately 750,000 beds. By 1965, the number of beds had decreased to 650,000; by 1980, the number was below 200,000. Specific treatment episodes (such as a drug regimen or electroconvulsive therapy) in state hospitals represented 49% of all psychiatric treatment in