Phasing down state hospitals: integrated versus nonintegrated services.

Two mental health catchment areas in Massachusetts that were in the process of phasing down state hospitals and building up community care provided an opportunity for studying the effectiveness of an integrated service delivery model and a nonintegrated model. The area that integrated state hospital and community services was more successful in the phase-down. It had a lower admission rate, the patients who were readmitted did not stay as long, and patients discharged spent more time in the community. Specific adminstrative and clinical structures that facilitated the patients' progress included investing community-based, administrative authority in one person; having a centralized intake and referral system; and using case managers to follow the clients through the service delivery system.