Am J Psychiatry 1990; 147:982-987
Copyright © 1990 by American Psychiatric Association
Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix
JL Geller, WH Fisher, JL Wirth-Cauchon and LJ Simon
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655.
A 1978 consent decree affecting one region of Massachusetts mandated a
drastic reduction of census at its state hospital, where considerable
deinstitutionalization had already occurred over the prior two decades. The
transfer of patients from hospital to community was to be accomplished
through the unprecedented expansion of community resources. This
second-generation deinstitutionalization effort achieved substantial census
reduction but less than was envisioned. It was most effective in
discharging geriatric and mentally retarded patients but far less effective
with longterm and new chronic patients, many of whom continue to require
repeated hospitalizations despite the availability of a comprehensive array
of community-based services.
