National Approach to the Evaluation of Community Mental Health Programs

Abstract

Operation-al data on persons coming under care in mental hospitals and outpatient psychiatric clinics can provide a starting point for planning and evaluating programs for the control of and reduction of disability from mental disorders. The Biometrics Branch of the National Institute of Mental Health has attempted to find elements common to the hospital and clinic programs in various states and to collect a body of uniform statistical data on these elements. Thus, the following findings based on data collected nationally have important implications for program planning and evaluation: (1) Analysis of 1st admission rates to public mental hospitals specific for age have revealed striking increases in the age group 65 and over. This has important implications for planning for alternative methods of providing care and treatment for persons with mental disorders of the senium. (2) A sudden widespread decrease in the population of the public mental hospitals of the nation between 1955 and 1956 emphasized the need for identifying specific segments of the hospital population in which changes are occurring and the need for follow-up studies to determine the subsequent fate of released patients. A plan for obtaining nationwide data on the movement of mental hospital populations in specific age, sex, diagnostic and length-of-stay categories has been instituted and follow-up studies are being planned in individual states. (3) A cooperative study of cohorts of admissions to 11 state mental hospital systems in 1954 revealed wide variation in probability of release within the 1st year following admission. This has led each of the states to investigate their programs closely to determine the reasons for these differences. (4) Low admission rates to outpatient clinics in certain age groups in a community in comparison with national figures have suggested groups for whom additional facilities are possibly needed or for whom case finding should be intensified. Because of the need to place data on patients coming under care in certain psychiatric facilities serving a community in their proper prospective, plans are now being implemented to extend national reporting to cover patients coming under care in all psychiatric facilities. The feasibility of collecting data from patients under care in paramedical facilities such as nursing homes, homes for the aged and family service agencies is also being investigated. Demonstration projects are being developed to coordinate data on patients in these various facilities serving a community to provide unduplicated counts of individuals coining under psychiatric care and to permit systematic analysis of information on the psychiatric treatment received by individuals over long periods of time.