On the basis of the principle that patients have the right to be treated
in the least restrictive setting appropriate to their needs, all 368
patients at Northampton State Hospital (Massachusetts) were discharged over
a 10-year period. Three-quarters were discharged to community settings.
Half of the patients were never rehospitalized, but many others continued
to display patterns of recidivism. On the assumption that socially
dysfunctional behavior would improve after discharge, the funded community
system emphasized assessments, residential placements, and crisis
intervention and deemphasized treatment. The findings raise many questions
about the efficacy and wisdom of attempting to serve an entire state
hospital population in the community.