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Monday, November 13, 2006

Olmstead Community Services Placements: Progress Slows

Comparing the 3 years before the Olmstead Supreme Court decision to the 3 years after it, researchers have found an 8% DECREASE in the decline in psychiatric institutionalization in state mental hospitals.

"Twenty years of national state hospital census data (1984-2003) were used to assess trends in the rate of declines from pre-to post-Olmstead periods. Data were organized into five four-year periods. Steady declines in the hospital census nationally were found over all periods, with especially large decreases in the 1990s. However, when the percent change in hospital census in the two periods immediately before the Olmstead decision (between 1992-1995 and 1996-1999) were compared with the percent change in the periods immediately before and immediately after the Olmstead decision (between 1996-1999 and 2000-2003), an 8 percent decrease in the magnitude of decline was seen. State hospital census continues to decline but has slowed significantly during the post-Olmstead period," wrote M.S. Salzer and colleagues, University of Pennsylvania, Center for Mental Health Policy and Services Research.

The researchers concluded: "More study of the factors associated with this decline is needed." 

Salzer and colleagues published their study in Psychiatric Services (State psychiatric hospital census after the 1999 Olmstead Decision: evidence of decelerating deinstitutionalization. Psychiatric Services, 2006;57(10):1501-4). Also in 11/13/06 Mental Health Wkly. Dig. 183, 2006 WLNR 19492161.

COMMENT: This may be coincidence. Or perhaps the Olmstead case prompted state officials to regroup and take some time to consider the effect of Olmstead. Another possibility is that states began to construct Olmstead plans at the departmental level, with a consequent reduction in top-directed placement efforts at the facility level.

I would speculate that these statistics have little practical significance. However, I would be concerned that it might be interpreted by advocates or administrators to have deep meaning, meaning beyond the merits of the findings.

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