Avoiding extinction: successful private psychiatric hospitals in the opening decade of the twenty-first century.

The history of the private psychiatric hospital has been characterized by the rise and demise of scores, if not hundreds of facilities. In recent years some well known, long-standing psychiatric hospitals have closed their doors. What has accounted for the ability of some of the private psychiatric hospitals to flourish? Two strategies are proposed: 1) progressive change through a broadened scope and a geographic spread, and 2) staying true to the institution's core mission with clinical and fiscal modifications at the perimeter of that mission. A case example is provided for each adaptation: Sheppard Pratt Health System (Baltimore) for the former; Austen Riggs Center (Stockbridge, Massachusetts) for the latter.