Doctor of Philosophy (PhD)
US state mental hospitals were rapidly depopulated in the decades following 1955. This was a demographic phenomenon of major proportion. The introduction of antipsychotics in 1954 has often been considered instrumental in this population movement. To date, studies of the role of antipsychotics in deinstitutionalization have been state specific, methodologically weak, inconsistent in their findings and fail to consider inter-state differences which could reveal previously unknown causal variables. This study used US Census data and pooled cross sectional time-series analysis to estimate the impact of chlorpromazine and policy changes on mental hospital population movement. To that end, the population movement of US state mental hospitals from 1925 to 1966 by state was analyzed. Furthermore, this study analyzes the overall resident count, discharges, first admissions and readmissions as well the resident count and first admissions of nine diagnostic categories and seven age groups. Population movement was assessed in relation to drug use using data on drug expenditure from a California State Senate survey conducted in 1956 within thirty states. This study found that the US mental hospital resident count significantly declined between 1954 and 1966 but the decline between 1954 and 1961 was accounted for by demographic changes in several diagnoses. However, schizophrenia was not among these diagnoses. The US resident count of patients with schizophrenia did not significantly decline between 1954 and 1961, a seven year period during which antipsychotics were in widespread use, but did significantly decline between 1961 and 1966. Moreover, drug expenditure as reported by the survey, did not appear to influence the movement of the population of patients with schizophrenia in those states studied. Lastly, the depopulation of US mental hospitals that occurred between 1954 and 1961 occurred among patients below age 55 whereas the depopulation between 1961 and 1966 occurred among patients aged 55 and over. This depopulation of the elderly occurred across diagnostic categories before the advent of Medicare and Medicaid and coincided with important policy changes in 1961. The central conclusion of this study is that policy change, not the advent of antipsychotics was responsible for deinstitutionalization.
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Lee Pow, Joni Maria, "A State-Level Analysis of Deinstitutionalization and the Impact of Chlorpromazine" (2015). LSU Doctoral Dissertations. 1357.