State psychiatric hospital census after the 1999 Olmstead Decision: evidence of decelerating deinstitutionalization

Psychiatr Serv. 2006 Oct;57(10):1501-4. doi: 10.1176/ps.2006.57.10.1501.


Objective: The Supreme Court ruled in the 1999 Olmstead decision that "unjustified isolation" of individuals with disabilities in institutions is a violation of the Americans With Disabilities Act. This study examined the extent to which state psychiatric hospital census across the United States has changed significantly post-Olmstead.

Methods: Twenty years of national state hospital census data (1984-2003) were used to assess trends in the rate of declines from pre- to post-Olmstead periods. Data were organized into five four-year periods.

Results: Steady declines in the hospital census nationally were found over all periods, with especially large decreases in the 1990s. However, when the percent change in hospital census in the two periods immediately before the Olmstead decision (between 1992-1995 and 1996-1999) were compared with the percent change in the periods immediately before and immediately after the Olmstead decision (between 1996-1999 and 2000-2003), an 8 percent decrease in the magnitude of decline was seen.

Conclusions: State hospital census continues to decline but has slowed significantly during the post-Olmstead period. More study of the factors associated with this decline is needed.

Publication types

  • Historical Article
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Censuses / history*
  • Decision Making*
  • Deinstitutionalization* / history
  • Deinstitutionalization* / legislation & jurisprudence
  • Deinstitutionalization* / statistics & numerical data
  • Diagnostic and Statistical Manual of Mental Disorders
  • Health Status
  • History, 20th Century
  • Hospitals, Psychiatric / statistics & numerical data*
  • Hospitals, State / statistics & numerical data*
  • Humans
  • Mental Disorders / diagnosis
  • Mental Disorders / epidemiology
  • Mental Disorders / rehabilitation
  • Mental Health Services / statistics & numerical data
  • Surveys and Questionnaires
  • United States / epidemiology