Is NIMH's Dream Coming True? Wyoming Centers Reduce State Hospital Admissions J o h n R. Doidge, Ph.D.* Charles W. Rodgers, Ph.D.
ABSTRACT: Do comprehensive community mental health services reduce admissions to state hospitals? A recent Nader report says no. Surprisingly few studies have documented the success of comprehensive community mental health programs. Wyoming had four unique characteristics that aided in evaluating the impact of centers on hospital admissions. The results of this study indicated that community-based comprehensive mental health ~ervices do, in fact, reduce psychiatric hospitalization. Since the final r e p o r t of the Joint C o m m i s s i o n o n Mental H e a l t h a n d Mental Illness (1961), a n explicit goal of m e n t a l h e a l t h p r o g r a m s has b e e n to s u p p l a n t the n e e d for hospitalizing patients in state m e n t a l hospitals. Bloom (1973) has criticized c o m m u n i t y m e n t a l health centers for rarely d o c u m e n t i n g the efficacy of their t r e a t m e n t activities. C h u a n d Trotter (1974) of " N a d e r ' s R a i d e r s " h a v e m o r e specifically q u e s tioned w h e t h e r N I M H - s p o n s o r e d centers h a v e a c c o m p l i s h e d their stated goals. N a d e r in his introduction to C h u a n d Trotter's (1974) b o o k , The Madness Establishment, stated: "One of the declared goals of the community mental health centers program--beyond reaching more people in need at the community level--was to reduce the number of admissions to state mental hospitals. For years, investigative reporters and other writers have depicted the horrible conditions in these 'human warehouses." For years, the public was temporarily shocked--before it looked the other way. With few exceptions, the community mental health centers program has not been traceably responsible for reducing the number of these hapless inmates." National Institute of Mental H e a l t h p e r s o n n e l , legislators, a n d citizens w h o finance m e n t a l health services h a v e s o u g h t evidence that centers are s u p p l a n t i n g the n e e d for m e n t a l hospitals. Scully a n d Windle (1973) c o m piled state hospital a d m i s s i o n data for 16 states to ascertain the i m p a c t of centers. T h e y f o u n d no consistent r e l a t i o n s h i p b e t w e e n the o p e n i n g of
*Dr. Doidge is Director of the Fremont Counseling Service (P.O. Box 618, Lander, Wyoming 82520), and Dr. Rodgers is Community Coordinator of the Riverton area. The Fremont Counseling Service is a regional mental health program in west central Wyoming and recently obtained a federal staffing grant under Public Law 89-105. The authors express appreciation to the Superintendent of the Wyoming State Hospital, Dr. William N. Karn, Jr., for his cooperation in making the admission data readily available. Community Mental Health Journal, Vol. 12 (4), 1976
399
400
Community Mental Health Journal
centers and changes in state hospital resident rates. They concluded that this indicated a failure by centers to fulfill one of the major goals of the centers. Their data suggested that there was a tendency for centers to have slightly more of an impact in reducing admissions in rural than in urban areas. To answer the question of whether mental health centers are supplanting the need for psychiatric hospitalizations in Wyoming, admission data for 1972 were collected to determine whether counties with mental health services had lower admission rates. Wyoming presented four unique characteristics that aided in answering this question. First, Wyoming is served by only one state hospital which meant that fluctuations in psychiatric hospitalizations statewide would be reflected in the admission rates to the state hospital. Second, in 1972 some areas of Wyoming were still without any mental health services; others had clinic services; and others had federally funded comprehensive programs. Third, counties with and without mental health services were fairly well balanced in regard to social indicators related to mental health problems (Campbell & Murray, 1974). Fourth, there had not been any administrative or legislative policy changes in Wyoming that by fiat altered the admission policy to the state hospital. These four characteristics facilitated evaluation of the impact of mental health services on state hospital admissions. If the existence of mental health services did, in fact, reduce the need for psychiatric hospitalization as purported by the community mental health centers movement, then counties without mental health services should have the highest admission rates to the Wyoming State Hospital. Conversely, those with the most comprehensive services should have the lowest admission rates. COMPREHENSIVE VERSUS CLINIC VERSUS NO SERVICES Wyoming's 23 counties were divided on the basis of those providing comprehensive, clinic, or no mental health services in 1972. Nine had comprehensive mental health services: federally funded programs that required providing at least the five basic services, to wit, outpatient, inpatient, intermediate care, emergency, and consultation and education; four had clinic services: providing outpatient and some consultation services; and ten were without services: no full-time personnel although limited itinerant services were available in some counties. The county admission rates per 10,000 population for 1972 are presented in Table 1. Population estimates obtained from the Wyoming State Department of Economic Planning and Development were used rather than the 1970 census data because of some population changes related to local economic booms. The average Wyoming admission rate was 20.6 persons per 10,000 population (717 admissions divided by 347,305, the state's population). The rate
John R. Doidge and Charles W. Rodgers
401
TABLE 1 1972 Admissions to the Wyoming State Hospital
Population Estimate
County
Admissions per 10,000 Population
Admissions Comprehensive S e r v i c e s
13,557 5,204 6,428 17,804 6,548 27,575 10,809 57,369 6,1~2 151,446
Campbell
Crook Johnson
Sheridan Weston Albany Goshen Laramie
Platte
10 1 27 1 37 16 88 6 189 No S e r v i c e s or C l i n i c
~Fremont ~Natrona ~Park *Sweetwater Big Horn Carbon Converse Hot S p r i n g s
Lincoln
Niobrara Sublette Teton
Unita Washakie TOTAL
33,563
56
51,489 18,538 21,421 10,270
128 39 49 20
14,099 6,635 4,906 8,383 2,775 3,905 4,830 7,092 7,953 195,859 347,305
74 10 16 17 8 10 10 67 2~ 527 716 S t a t e
r C o u n t i e s with menta'l health c l i n i c
Mean
7.4 1.9 4.7 15.2 1.5 13.4 14.8 15.3 9.8 12.5
Services
16.7 24.9 21.0 22.9 19.5 52 5 15 1
Mean Mean
32 6 20 3 28 8 25 6 20 7 94.5 28.9 26,9 20.6
services
for counties w i t h c o m p r e h e n s i v e services w a s 12.5; for clinic services, 21.8; for counties with n o services, 36.0. All these differences w e r e in the exp e c t e d direction. For all counties w i t h o u t c o m p r e h e n s i v e services, that is, t h o s e w i t h n o services or clinic services, the a v e r a g e a d m i s s i o n rate w a s 26.9 p e r 10,000 as c o m p a r e d to 12.5 for counties w i t h c o m p r e h e n s i v e services. T h e significance of this difference u s i n g the M a n n - W h i t n e y U Test w a s significant b e y o n d the .001 level. R E P L I C A T I O N FOR 1969 To d e t e r m i n e w h e t h e r c o m p r e h e n s i v e m e n t a l health Services r e d u c e d a d m i s s i o n rates to the state hospital d u r i n g a n o t h e r year, the a u t h o r s collected the s a m e i n f o r m a t i o n for 1969. This i n f o r m a t i o n is p r e s e n t e d in Table 2. It s h o u l d be n o t e d t h a t in 1969 there w e r e five counties with c o m p r e h e n s i v e services, s e v e n w i t h clinics, a n d eleven with n o services.
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TABLE 2 1969 Admissions to the Wyoming State Hospital
County
Campbell Crook Johnson Sheridan Weston
Population Estimate
8,890 5,180 5,324 18,228 6,473 44,094
Admissions per 10,000 Population
Admissions
Comprehensive S e r v i c e s 19 4 6 26 __2 57
Mean
21.4 7.7 11.3 14.3 ~.1 12.9
*Albany
No S e r v i c e s on C l i n i c S e r v i c e s 24,125 34
14.1
*Goshen
10,521
22
20.9
r ~Natrona
53,644
132
24.6
47,404 186 r 15,910 35 *Platte 6,179 7 4~Sweetwater 17,136 40 Bi9 Horn 9,679 19 Carbon 12,637 37 Converse 5,902 7 Fremont 26,345 74 Hot S p r i n g s 4,712 21 Lincoln 8,502 19 Niobraea 3,157 8 Sublette 3,612 5 Teton 4,343 4 Uinta 7,630 41 Washakie 7t202 1..~2 268,640 703 Mean TOTAL 312,734 760 State Mean *Counties with Mental Health C l i n i c S e r v i c e s
39.2 22.0 11.3 23.3 19.6 29.3 11.9 28.1 44.6 22.3 25.3 13.8 9.2 53.7 16.7 26.2 24.3
The W y o m i n g a d m i s s i o n rate for 1969 w a s 24.3 a d m i s s i o n s p e r 10,000 as c o m p a r e d to 20.6 for 1972. The rate for counties with c o m p r e h e n s i v e services w a s 12.9 (12.5 for 1972), for clinic services 26.1 (21.8 for 1972), a n d for counties with no services 26.4 (36.0 for 1972). The rate for all counties w i t h o u t c o m p r e h e n s i v e m e n t a l health services w a s 26.2 as c o m p a r e d to 12.9 for those counties w i t h c o m p r e h e n s i v e services. Using the M a n n - W h i t n e y U Test, the significance s u r p a s s e d the .05 level. This p a t t e r n w a s similar to the 1972 data a n d again s u p p o r t e d the interpretation that c o m p r e h e n s i v e services significantly r e d u c e d the n u m b e r of a d m i s s i o n s to the W y o m i n g State Hospital. B e t w e e n 1969 a n d 1972 the overall state a d m i s s i o n rate d r o p p e d f r o m 24.3 to 20.6 a n d this decrease a p p e a r e d to be attributable to the r e d u c t i o n in a d m i s s i o n s f r o m those counties that initiated or m a i n t a i n e d c o m p r e h e n sive m e n t a l health services. It w a s s o m e w h a t surprising that the overall state reduction in a d m i s s i o n rates occured despite the fact t h a t the a d m i s sion rate for counties w i t h o u t services increased f r o m 25.7 in 1969 to 36.0 for 1972.
John R. Doidge and Charles W. Rodgere
403
U S I N G C O U N T I E S AS THEIR O W N C O N T R O L S If the o v e r a l l state r e d u c t i o n in a d m i s s i o n rate to t h e state h o s p i t a l w a s a t t r i b u t a b l e to t h e a d v e n t of m e n t a l h e a l t h services in s o m e c o u n t i e s , t h e n it c o u l d be r e a s o n e d t h a t t h o s e c o u n t i e s t h a t i n i t i a t e d riew m e n t a l h e a l t h services b e t w e e n 1969 a n d 1972 s h o u l d h a v e s h o w n t h e g r e a t e s t r e d u c t i o n in a d m i s s i o n rates. F o u r c o u n t i e s ( A l b a n y , G o s h e n , L a r a m i e , a n d Platte) c h a n g e d f r o m a clinic d e l i v e r y s y s t e m to c o m p r e h e n -
TABLE 3
Admissions per 10,000 Population to the Wyoming State Hospital A.
C o u n t i e s which changed from c i n i c s e r v i c e s t o comprehensive services. 1972 1969 Albany 14.1 13.4 14.8 Goshen 20.9 Laramie 24.6 15.3 Platte 11.~ 9.8 Mean 20.6 14.4
B.
C o u n t i e s w h i c h had comprehens ve s e r v i c e s
Campbell
Crook Johnson Sheridan Ueston
Mean C.
1972 7.4
7.7
1.9 4.7 15.2 1.5 8.4
11.3 14.3 3.1 12.9
1969 28,1
C o u n t i e s which had c l i n i c Natrona Park Sweetwater
E.
1969 21.4
C o u n t i e s which changed from no s e r v i c e s t o c l i n i c Fremont
D.
in 1969 and 1972.
services
1969 39.2 22.0 23.~ Mean 34.2
1972 16.7 in 1969 and 1972. 1972 24.9 21.0 22.9 23.6
C o u n t i e s which had no s e r v i c e s in 1969 and 1972. 1969 19.6 29.3 11.9 44.6 22.3 25.3 13.8
Big Horn Carbon Converse Hot S p r i n g s Lincoln
Niobrara Sublette Teton Unita Washakie Mean
services.
1972 19;5 52.5 15.1 32.6 20.3 28.8 25.6
9.2
20.7
53-7 16.7 25.7
94.5 28.9 36.0
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Community Mental Health Journal
sive services between 1969 and 1972 (Table 3 Section A). As predicted each of these counties had a reduction in admission rate. Despite an 8% population increase in these counties, the number of admissions dropped 25% (195 in 1969; 147 in 1972). One county, Fremont (Table 3, Section C), changed from no services to clinic services between 1969 and 1972 and had a decrease in admission rate from 28.1 per 10,000 population to 16.7. Again, despite a population increase of 27%, there was a 24% decrease in admissions to the Wyoming State Hospital (74 in 1969; 56 in 1972). The average admission rate for counties with no services increased between 1969 and 1972 (Table 3, Section E). Very strikingly for all counties in which mental health services were either maintained, improved, or initiated, there was a decrease in the admission rate. Thus mental health services appeared to have counteracted a trend toward increased hospital admissions. CONCLUSIONS 1. Counties with comprehensive mental health services had a significantly lower admission rate to the state hospital than counties without comprehensive services. 2. When a county initiated or expanded its community mental health services, its admission rate decreased. 3. Admission rates increased in counties without mental health services. 4. This study firmly supported the contention that community mental health services will reduce psychiatric hospitalizations.
REFERENCES Joint Commission on Mental Health and Mental Illness. Action for mental health: Final report of the Joint Commission on Mental Illness and Health. New York: Wiley, 1961. Bloom, B.L. Community mental health: A historical and critical analysis. Morristown, N. J.: General Learning Press, 1973. Campbell, M., & Murray, B. An overview of mental health resources and issues (Working draft No. 2). Cheyenne, Wyo.: State of Wyoming Joint Education, Health and Welfare Interim Committee, 1974. Chu, F. D., & Trotter, S. The madness establishment. New York: Grossman, 1974. Scully, D., & Windle, C. An empirical study of the impact of federally funded community mental health centers on state mental hospital utilization. (A report to NIMH on Contract No. HSM 42-73-70.) Rockville, Md.: National Institute of Mental Health, 1973.
ABSTRACT: Do comprehensive community mental health services reduce admissions to state hospitals? A recent Nader report says no. Surprisingly few studies have documented the success of comprehensive community mental health programs. Wyoming had four unique characteristics that aided in evaluating the impact of centers on hospital admissions. The results of this study indicated that community-based comprehensive mental health ~ervices do, in fact, reduce psychiatric hospitalization. Since the final r e p o r t of the Joint C o m m i s s i o n o n Mental H e a l t h a n d Mental Illness (1961), a n explicit goal of m e n t a l h e a l t h p r o g r a m s has b e e n to s u p p l a n t the n e e d for hospitalizing patients in state m e n t a l hospitals. Bloom (1973) has criticized c o m m u n i t y m e n t a l health centers for rarely d o c u m e n t i n g the efficacy of their t r e a t m e n t activities. C h u a n d Trotter (1974) of " N a d e r ' s R a i d e r s " h a v e m o r e specifically q u e s tioned w h e t h e r N I M H - s p o n s o r e d centers h a v e a c c o m p l i s h e d their stated goals. N a d e r in his introduction to C h u a n d Trotter's (1974) b o o k , The Madness Establishment, stated: "One of the declared goals of the community mental health centers program--beyond reaching more people in need at the community level--was to reduce the number of admissions to state mental hospitals. For years, investigative reporters and other writers have depicted the horrible conditions in these 'human warehouses." For years, the public was temporarily shocked--before it looked the other way. With few exceptions, the community mental health centers program has not been traceably responsible for reducing the number of these hapless inmates." National Institute of Mental H e a l t h p e r s o n n e l , legislators, a n d citizens w h o finance m e n t a l health services h a v e s o u g h t evidence that centers are s u p p l a n t i n g the n e e d for m e n t a l hospitals. Scully a n d Windle (1973) c o m piled state hospital a d m i s s i o n data for 16 states to ascertain the i m p a c t of centers. T h e y f o u n d no consistent r e l a t i o n s h i p b e t w e e n the o p e n i n g of
*Dr. Doidge is Director of the Fremont Counseling Service (P.O. Box 618, Lander, Wyoming 82520), and Dr. Rodgers is Community Coordinator of the Riverton area. The Fremont Counseling Service is a regional mental health program in west central Wyoming and recently obtained a federal staffing grant under Public Law 89-105. The authors express appreciation to the Superintendent of the Wyoming State Hospital, Dr. William N. Karn, Jr., for his cooperation in making the admission data readily available. Community Mental Health Journal, Vol. 12 (4), 1976
399
400
Community Mental Health Journal
centers and changes in state hospital resident rates. They concluded that this indicated a failure by centers to fulfill one of the major goals of the centers. Their data suggested that there was a tendency for centers to have slightly more of an impact in reducing admissions in rural than in urban areas. To answer the question of whether mental health centers are supplanting the need for psychiatric hospitalizations in Wyoming, admission data for 1972 were collected to determine whether counties with mental health services had lower admission rates. Wyoming presented four unique characteristics that aided in answering this question. First, Wyoming is served by only one state hospital which meant that fluctuations in psychiatric hospitalizations statewide would be reflected in the admission rates to the state hospital. Second, in 1972 some areas of Wyoming were still without any mental health services; others had clinic services; and others had federally funded comprehensive programs. Third, counties with and without mental health services were fairly well balanced in regard to social indicators related to mental health problems (Campbell & Murray, 1974). Fourth, there had not been any administrative or legislative policy changes in Wyoming that by fiat altered the admission policy to the state hospital. These four characteristics facilitated evaluation of the impact of mental health services on state hospital admissions. If the existence of mental health services did, in fact, reduce the need for psychiatric hospitalization as purported by the community mental health centers movement, then counties without mental health services should have the highest admission rates to the Wyoming State Hospital. Conversely, those with the most comprehensive services should have the lowest admission rates. COMPREHENSIVE VERSUS CLINIC VERSUS NO SERVICES Wyoming's 23 counties were divided on the basis of those providing comprehensive, clinic, or no mental health services in 1972. Nine had comprehensive mental health services: federally funded programs that required providing at least the five basic services, to wit, outpatient, inpatient, intermediate care, emergency, and consultation and education; four had clinic services: providing outpatient and some consultation services; and ten were without services: no full-time personnel although limited itinerant services were available in some counties. The county admission rates per 10,000 population for 1972 are presented in Table 1. Population estimates obtained from the Wyoming State Department of Economic Planning and Development were used rather than the 1970 census data because of some population changes related to local economic booms. The average Wyoming admission rate was 20.6 persons per 10,000 population (717 admissions divided by 347,305, the state's population). The rate
John R. Doidge and Charles W. Rodgers
401
TABLE 1 1972 Admissions to the Wyoming State Hospital
Population Estimate
County
Admissions per 10,000 Population
Admissions Comprehensive S e r v i c e s
13,557 5,204 6,428 17,804 6,548 27,575 10,809 57,369 6,1~2 151,446
Campbell
Crook Johnson
Sheridan Weston Albany Goshen Laramie
Platte
10 1 27 1 37 16 88 6 189 No S e r v i c e s or C l i n i c
~Fremont ~Natrona ~Park *Sweetwater Big Horn Carbon Converse Hot S p r i n g s
Lincoln
Niobrara Sublette Teton
Unita Washakie TOTAL
33,563
56
51,489 18,538 21,421 10,270
128 39 49 20
14,099 6,635 4,906 8,383 2,775 3,905 4,830 7,092 7,953 195,859 347,305
74 10 16 17 8 10 10 67 2~ 527 716 S t a t e
r C o u n t i e s with menta'l health c l i n i c
Mean
7.4 1.9 4.7 15.2 1.5 13.4 14.8 15.3 9.8 12.5
Services
16.7 24.9 21.0 22.9 19.5 52 5 15 1
Mean Mean
32 6 20 3 28 8 25 6 20 7 94.5 28.9 26,9 20.6
services
for counties w i t h c o m p r e h e n s i v e services w a s 12.5; for clinic services, 21.8; for counties with n o services, 36.0. All these differences w e r e in the exp e c t e d direction. For all counties w i t h o u t c o m p r e h e n s i v e services, that is, t h o s e w i t h n o services or clinic services, the a v e r a g e a d m i s s i o n rate w a s 26.9 p e r 10,000 as c o m p a r e d to 12.5 for counties w i t h c o m p r e h e n s i v e services. T h e significance of this difference u s i n g the M a n n - W h i t n e y U Test w a s significant b e y o n d the .001 level. R E P L I C A T I O N FOR 1969 To d e t e r m i n e w h e t h e r c o m p r e h e n s i v e m e n t a l health Services r e d u c e d a d m i s s i o n rates to the state hospital d u r i n g a n o t h e r year, the a u t h o r s collected the s a m e i n f o r m a t i o n for 1969. This i n f o r m a t i o n is p r e s e n t e d in Table 2. It s h o u l d be n o t e d t h a t in 1969 there w e r e five counties with c o m p r e h e n s i v e services, s e v e n w i t h clinics, a n d eleven with n o services.
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Community Mental Health Journal
TABLE 2 1969 Admissions to the Wyoming State Hospital
County
Campbell Crook Johnson Sheridan Weston
Population Estimate
8,890 5,180 5,324 18,228 6,473 44,094
Admissions per 10,000 Population
Admissions
Comprehensive S e r v i c e s 19 4 6 26 __2 57
Mean
21.4 7.7 11.3 14.3 ~.1 12.9
*Albany
No S e r v i c e s on C l i n i c S e r v i c e s 24,125 34
14.1
*Goshen
10,521
22
20.9
r ~Natrona
53,644
132
24.6
47,404 186 r 15,910 35 *Platte 6,179 7 4~Sweetwater 17,136 40 Bi9 Horn 9,679 19 Carbon 12,637 37 Converse 5,902 7 Fremont 26,345 74 Hot S p r i n g s 4,712 21 Lincoln 8,502 19 Niobraea 3,157 8 Sublette 3,612 5 Teton 4,343 4 Uinta 7,630 41 Washakie 7t202 1..~2 268,640 703 Mean TOTAL 312,734 760 State Mean *Counties with Mental Health C l i n i c S e r v i c e s
39.2 22.0 11.3 23.3 19.6 29.3 11.9 28.1 44.6 22.3 25.3 13.8 9.2 53.7 16.7 26.2 24.3
The W y o m i n g a d m i s s i o n rate for 1969 w a s 24.3 a d m i s s i o n s p e r 10,000 as c o m p a r e d to 20.6 for 1972. The rate for counties with c o m p r e h e n s i v e services w a s 12.9 (12.5 for 1972), for clinic services 26.1 (21.8 for 1972), a n d for counties with no services 26.4 (36.0 for 1972). The rate for all counties w i t h o u t c o m p r e h e n s i v e m e n t a l health services w a s 26.2 as c o m p a r e d to 12.9 for those counties w i t h c o m p r e h e n s i v e services. Using the M a n n - W h i t n e y U Test, the significance s u r p a s s e d the .05 level. This p a t t e r n w a s similar to the 1972 data a n d again s u p p o r t e d the interpretation that c o m p r e h e n s i v e services significantly r e d u c e d the n u m b e r of a d m i s s i o n s to the W y o m i n g State Hospital. B e t w e e n 1969 a n d 1972 the overall state a d m i s s i o n rate d r o p p e d f r o m 24.3 to 20.6 a n d this decrease a p p e a r e d to be attributable to the r e d u c t i o n in a d m i s s i o n s f r o m those counties that initiated or m a i n t a i n e d c o m p r e h e n sive m e n t a l health services. It w a s s o m e w h a t surprising that the overall state reduction in a d m i s s i o n rates occured despite the fact t h a t the a d m i s sion rate for counties w i t h o u t services increased f r o m 25.7 in 1969 to 36.0 for 1972.
John R. Doidge and Charles W. Rodgere
403
U S I N G C O U N T I E S AS THEIR O W N C O N T R O L S If the o v e r a l l state r e d u c t i o n in a d m i s s i o n rate to t h e state h o s p i t a l w a s a t t r i b u t a b l e to t h e a d v e n t of m e n t a l h e a l t h services in s o m e c o u n t i e s , t h e n it c o u l d be r e a s o n e d t h a t t h o s e c o u n t i e s t h a t i n i t i a t e d riew m e n t a l h e a l t h services b e t w e e n 1969 a n d 1972 s h o u l d h a v e s h o w n t h e g r e a t e s t r e d u c t i o n in a d m i s s i o n rates. F o u r c o u n t i e s ( A l b a n y , G o s h e n , L a r a m i e , a n d Platte) c h a n g e d f r o m a clinic d e l i v e r y s y s t e m to c o m p r e h e n -
TABLE 3
Admissions per 10,000 Population to the Wyoming State Hospital A.
C o u n t i e s which changed from c i n i c s e r v i c e s t o comprehensive services. 1972 1969 Albany 14.1 13.4 14.8 Goshen 20.9 Laramie 24.6 15.3 Platte 11.~ 9.8 Mean 20.6 14.4
B.
C o u n t i e s w h i c h had comprehens ve s e r v i c e s
Campbell
Crook Johnson Sheridan Ueston
Mean C.
1972 7.4
7.7
1.9 4.7 15.2 1.5 8.4
11.3 14.3 3.1 12.9
1969 28,1
C o u n t i e s which had c l i n i c Natrona Park Sweetwater
E.
1969 21.4
C o u n t i e s which changed from no s e r v i c e s t o c l i n i c Fremont
D.
in 1969 and 1972.
services
1969 39.2 22.0 23.~ Mean 34.2
1972 16.7 in 1969 and 1972. 1972 24.9 21.0 22.9 23.6
C o u n t i e s which had no s e r v i c e s in 1969 and 1972. 1969 19.6 29.3 11.9 44.6 22.3 25.3 13.8
Big Horn Carbon Converse Hot S p r i n g s Lincoln
Niobrara Sublette Teton Unita Washakie Mean
services.
1972 19;5 52.5 15.1 32.6 20.3 28.8 25.6
9.2
20.7
53-7 16.7 25.7
94.5 28.9 36.0
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Community Mental Health Journal
sive services between 1969 and 1972 (Table 3 Section A). As predicted each of these counties had a reduction in admission rate. Despite an 8% population increase in these counties, the number of admissions dropped 25% (195 in 1969; 147 in 1972). One county, Fremont (Table 3, Section C), changed from no services to clinic services between 1969 and 1972 and had a decrease in admission rate from 28.1 per 10,000 population to 16.7. Again, despite a population increase of 27%, there was a 24% decrease in admissions to the Wyoming State Hospital (74 in 1969; 56 in 1972). The average admission rate for counties with no services increased between 1969 and 1972 (Table 3, Section E). Very strikingly for all counties in which mental health services were either maintained, improved, or initiated, there was a decrease in the admission rate. Thus mental health services appeared to have counteracted a trend toward increased hospital admissions. CONCLUSIONS 1. Counties with comprehensive mental health services had a significantly lower admission rate to the state hospital than counties without comprehensive services. 2. When a county initiated or expanded its community mental health services, its admission rate decreased. 3. Admission rates increased in counties without mental health services. 4. This study firmly supported the contention that community mental health services will reduce psychiatric hospitalizations.
REFERENCES Joint Commission on Mental Health and Mental Illness. Action for mental health: Final report of the Joint Commission on Mental Illness and Health. New York: Wiley, 1961. Bloom, B.L. Community mental health: A historical and critical analysis. Morristown, N. J.: General Learning Press, 1973. Campbell, M., & Murray, B. An overview of mental health resources and issues (Working draft No. 2). Cheyenne, Wyo.: State of Wyoming Joint Education, Health and Welfare Interim Committee, 1974. Chu, F. D., & Trotter, S. The madness establishment. New York: Grossman, 1974. Scully, D., & Windle, C. An empirical study of the impact of federally funded community mental health centers on state mental hospital utilization. (A report to NIMH on Contract No. HSM 42-73-70.) Rockville, Md.: National Institute of Mental Health, 1973.
