Business as usual--at the state mental hospital.

Despite official policy and professional emphasis to the contrary, the custodial mental hospital continues to exist as a major form of state-provided mental health care. In this paper, one such institution, "New England State Hospital", is described, and the various features of hospital organization that sustain a system of custodial care are discussed. Although the custodial hospital offers little to its patients, its persistent survival can be explained by the number of non-patient vested interests that are well served by the state hospital, precisely in its existing custodial form. The case study of New England State Hospital suggests that reform of state mental institutions depends less on a programmatic formulation of desired changes than on an understanding of the structured resistance to such changes.