Who really treats the severely impaired young adult patient? A comparison of treatment settings.

To make informed decisions about allocation of resources between state hospitals and community services, it is necessary to have comparable data on patients being served in both kinds of settings. Using a random sample of 611 severely impaired young adult patients with major mental illnesses, a study in Missouri compared those who were treated in state-operated facilities with those treated in private, not-for-profit community mental health centers that received state funds. A major finding was that young adult patients were more likely to be treated in a state-operated facility, and that 89 percent of inpatient admissions of this group were made to state-operated facilities. Compared with patients seen in the centers, those served by state facilities were more likely to have histories of arrests or violence, to be minority-group members, to be poor or unemployed, to have a diagnosis of schizophrenia, and to come from more urbanized areas. Of the 26 percent of the sample defined as chronic patients, 73 percent were treated at state-operated facilities.