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Abstract
This research proposes a framework for investigating US mental healthcare system performance and operationalizes it using a set of routinely collected administrative data. This research assesses changing patterns and trends in acute psychiatry use for the geographically-defined population of New York City residents from 1983 to 2000, a period marked by continued depopulation of state psychiatric facilities, devolution of federal responsibility for social services, managed care downsizing of the acute inpatient sector, and the deregulation of short-stay hospitals. The results of multi-variate statistical analyses are presented and interpreted with respect to systemic patterns and trends and in the context of findings from previous research. Acute psychiatry for the New York City population is characterized as an increasingly publicly-subsidized mental healthcare subsystem where not-for-profit hospitals are replacing public ones as the primary provider of inpatient care to a population that is disproportionately and increasingly male, younger and of non-white race-ethnicity. Access to this subsystem is predominantly through emergency rooms and decreasingly via clinical referral. Psychiatric inpatients are overwhelmingly discharged to ‘the community’ and with a diminishing probability of discharge to a long term psychiatric care facility. The evidence presented associates disparities in individual treatment duration with differences in provider, payer and patient characteristics, including racial-ethnic origin, and with alternative pathways to and from inpatient care. Assessment of changing patterns and trends in the frequency of acute psychiatry use shows these disparities extend from individual treatment to the comparative accessibility of appropriate care for various sub-populations. Findings of this analysis reflect allocative inefficiencies and disequilibria across the supra-system of care. The study concludes that dilution of US Federal government oversight and accountability over the course of the last two decades has diminished the prospects of exercising adequate managerial control over factors, systemic or specific, which impede the equitable provision of quality mental healthcare.
