Beyond the old state hospital: new opportunities ahead.

Despite criticism from many quarters, the state hospitals continue to perform important roles in patient care, evidenced by increasing admissions in recent years. The hospitals serve as back-up facilities for patients who cannot be treated in community settings, and, because of their size, they are able to offer specialized services that community-based programs cannot provide. In addition, smaller patient populations and stricter rules about adequacy of staff and treatment programs have opened up new opportunities for hospitals to move into other important areas involving affiliation with academic centers, such as professional training and clinical research. Because of the state hospital's central role in a growing number of legal and public policy issues, professionals in such facilities must become active participants in the decision-making processes that shape mental health policy and determine the quality of patient care.