Whether state hospitals have a role in caring for mentally ill persons has been intensely debated for the past decade. During this time the inpatient census of public mental hospitals has fallen dramatically from 490,000 to 215,000 owing to increasingly effective treatment programs for acutely and chronically psychotic patients. The vast majority of patients currently cared for in state hospitals could be adequately treated in the community if a comprehensive spectrum of psychiatric services and residential alternatives were established. The failure to establish this network of community services before the discharge of thousands of patients has discredited the deinstitutionalization programs in many states, including California and New York, and forced California to abandon its plan to phase out all its state hospitals. Thus, although phase out of state hospitals is clinically feasible, it is unlikely at present since the fiscal and ideologic commitment to shift to community-based treatment is lacking.
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