Effectiveness of inpatient treatment programs for mentally ill adults in public psychiatric facilities*

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Abstract

This article updates the current state of knowledge and research on the effectiveness of inpatient treatment programs for mentally ill adults in the public sector to provide guidance for improving both research and services. National figures show inpatient facilities to still be predominant in the U.S. public mental health system; the populations and programs in these facilities are in serious need of science-based assistance. We summarize the major conceptual factors that influence the conduct and interpretation of inpatient outcome studies, clinical trials, or program evaluations (relevant domains and classes of variables, unit of analysis and effectiveness criteria, empirical findings on moderator variables). The major inpatient treatment approaches are described, and the empirical literature on effectiveness is reviewed. We conclude with a summary of the substantial accumulated evidence and recommendations for use of new assessment technology to assist with implementation of effective approaches and for advancing promising lines of research. The time seems ripe for exciting science-based advances in research and services.

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    *

    Throughout this paper the term “mentally ill” is used without qualification. This term is merely a communicative convenience, referring to persons who suffer from severe emotional, behavioral, and mental problems and disabilities that are typically associated with the term. Despite the authoritative pronouncements of many, there is no solid evidence that the basis for these severe problems lies either in brain disease or in malevolent parent-child interaction; specific causative factors are generally unknown and typically remain at the level of strengthened hypotheses that interactively involve biological, psychological, and social factors for any given individual or group (see Paul, 1990; Paul & Lentz, in press). The term “patient” is similarly used in this paper because the majority of clientele in hospital treatment settings are traditionally referred to in this manner. The authors prefer the terms “client” or “consumer” to refer to the recipients of services in any setting, and the reader so disposed can make the appropriate substitution.

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    Copyright © 1992 Published by Elsevier Ltd.