International Journal of Technology Assessment in Health Care

Special Section: The Assessment of Psychiatry

Assessing Psychiatric Care Settings: Hospitalization Versus Outpatient Care

Mary L. Durhama1 and John Q. La Fonda2

a1 Kaiser Permanente Center for Health Research

a2 Seattle University School of Law


This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.