A historical perspective on the role of state hospitals viewed from the era of the "revolving door"

OBJECTIVE: By focusing on the functioning of a state hospital throughout its existence, the author provides a historical perspective on the nature and causes of "revolving door" admissions. METHOD: Northampton State Hospital was chosen as a prototype, and data on characteristics of patients and patterns of hospital utilization were analyzed from three 10-year periods: 1880-1889, 1930-1939, and 1980- 1989. The data for the first two time periods came from the hospital's admission and discharge logbooks and its annual reports; the material for the most recent decade was obtained from unpublished yearly reports generated by the hospital's medical records department. RESULTS: The hospital operated very differently in each of the decades analyzed, but only in the 1980s was recidivism a major finding. This was not, as has often been thought, due to problems or populations unique to the state hospital in the 1980s nor to the fact that in earlier eras the state hospital rarely discharged patients. The once-large asylum has been replaced by a facility rapidly admitting and discharging patients, many of whom have accumulated more than 10 lifetime admissions, in a pattern of care not previously noted. CONCLUSIONS: State hospitals have functioned in different yet questionable ways throughout their history. Their current role of providing a revolving-door pattern of care to a considerable population is rooted in a contemporary shift in ideology. This role for state hospitals appears to make no more sense than did their earlier role as neglected and neglectful asylums, and it should be reevaluated.