The limits of general hospital care: a continuing role for state hospitals.

An examination of the characteristics of patients transferred to a state hospital after their treatment in a rural community general hospital had failed provides some data for defining the state hospital's role in relation to such patients. Of 2,128 discharges from the general hospital in a three-year period, 33, or 1.6 percent, were referred to the state hospital. The patients could be divided into four subgroups: violent patients, unresponsive patients with severely disorganized mental states, dependent patients treated successfully but referred because of a lack of community residential facilities, and deteriorating alcoholic recidivists who had proved to be unresponsive to treatment. At follow-up, the most improvements had occurred among the unresponsive subgroup. The author believes that, among those subgroups, state hospitals are most useful for violent patients, for deteriorating recidivist alcoholics, and, depending on further research, possibly for unresponsive patients.