Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Adolescent; Adult; Aged; Community Mental Health Services; distribution; Costs and Cost Analysis; Deinstitutionalization; Diagnosis-Related Groups; Hospitals, Psychiatric; Hospitals, Public; Hospitals, State; Humans; Length of Stay; Massachusetts; Mental Disorders; Middle Aged; Patient Advocacy


Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology


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.


Am J Psychiatry. 1990 Aug;147(8):982-7.

Journal/Book/Conference Title

The American journal of psychiatry

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Link to Article in PubMed

PubMed ID