This technical report is advocacy for state psychiatric hospitals to be a vital part of the continuum of recovery services that should be integrated with a robust set of community services. Recommendations are provided for improving community integration, state psychiatric hospital services and operations, and policies on all system levels. This report is not advocacy for increasing state psychiatric hospitals or beds.
To support and justify the recommendations, the report includes background and discussion on the history and current context of state psychiatric hospitals; data and trends; how admission decisions to state psychiatric hospitals are made; the impact of the 1999 Olmstead Supreme Court decision; financing; the use of technology; and what the environment and culture of state psychiatric hospitals should be. The major findings and messages from the report and recommendations are the following:
• State psychiatric hospitals are a vital part of the continuum of care and should be recovery-oriented and integrated with a robust set of community services.
• All people served in state psychiatric hospitals should be considered to be in the process of recovery.
• Service recipients should be served in the most integrated and least restrictive environment possible.
• Changing the culture and environment of state psychiatric hospitals are keys to providing effective care. Cultures should be recovery-oriented; trauma-informed; culturally and linguistically competent; and address health and wellness.
• Peer support services are an integral part of assisting with people’s recovery process and should be made available to all service recipients in state psychiatric hospitals. Peer support specialists should be made an equal member of the treatment team.
• A state psychiatric hospital is not a person’s home. State psychiatric hospitals should be focused on service recipients returning to the community quickly when they no longer meet in patient criteria.
• State psychiatric hospital staff, in partnership with the service recipient, should work directly with community providers on a discharge plan that includes what community services would be most helpful for the service recipient.
• For forensic service recipients, sex offenders, and in many states involuntarily committed service recipients, decisions for admission and discharge are made by courts and not by the state psychiatric hospital.
• State psychiatric hospitals include people with mental illness, people with criminal behavior driven by mental illness, and people with criminal and predatory behavior with no mental illness. These populations should be served in discrete locations.
• It is the duty of the state psychiatric hospital to make reasonable efforts to create environments in which service recipients and staff are as safe as possible. Addressing safety needs should be trauma-informed.
• Leadership and a well-trained, professional and paraprofessional workforce are paramount in ensuring quality care. …..