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Am J Psychiatry 1981; 138:736-749
Copyright © 1981 by American Psychiatric Association
Overview: deinstitutionalization of psychiatric patients, a critical review of outcome studies
P Braun, G Kochansky, R Shapiro, S Greenberg, JE Gudeman, S Johnson and MF Shore
The authors performed a critical review of experimental studies on the
outcomes for psychiatric patients of 1) alternatives to hospital admission,
2) modifications of conventional hospitalization, and 3) alternatives to
continued long-term hospitalization. The internal validity of many of the
studies was compromised by shortcomings in design and performance and
generalizability limited by selection of patient populations. With these
qualifications experimental alternatives to hospital care of patients have
led to psychiatric outcomes not different from and occasionally superior to
those of patients in control groups. This conclusion is best supported for
alternatives to admission and for modifications of conventional
hospitalization. The available studies do not permit firm conclusions
regarding alternatives to continued long-term hospitalization of
chronically ill patients or for a critical analysis of the optimal
management of specific subpopulations of psychiatric patients. Satisfactory
deinstitutionalization appears to depend on the availability of appropriate
programs for care in the community.
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