Long-Stay Inpatient Care in a Psychiatric Hospital: Three Decades of Transition Toward Community-Based Mental Health Care

Abstract

Introduction: The transition from the asylum-based model to community-based mental health care has led to a sustained reduction in long-stay psychiatric hospitalizations, although important questions remain regarding the characteristics of the population that continues to be institutionalized. The aim of this study was to analyze the evolution of long-stay psychiatric hospitalizations at Dr. Alejandro Korn Hospital, La Plata, Argentina, between 1995 and 2023. Methods: An observational, descriptive, comparative, repeated cross-sectional series study was conducted based on four censuses performed in long-stay wards in 1995, 2009, 2021, and 2023. Results: The number of hospitalized patients declined from 1,048 to 86, while long-stay wards decreased from 23 to 5. The mean age increased from 52.9 to 61.3 years, and the proportion of men rose from 44.2% to 72.1%. Schizophrenia remained the predominant diagnosis (44–53%), whereas the proportion of patients with intellectual disability increased from 28% to 44%. In 2023, 67.4% of patients had been hospitalized for more than 20 years, and 38.4% had remained continuously hospitalized since 1995. Discussion: Despite the marked reduction in the institutionalized population, a core group of patients with extremely prolonged hospitalizations remained. These findings suggest that psychiatric bed reduction alone is not a sufficient indicator of successful deinstitutionalization. Furthermore, the high proportion of in-hospital deaths and transfers to other institutions documented during the reform process suggests that part of this transformation may be better understood as transinstitutionalization, underscoring the need to strengthen community-based services capable of providing intensive, long-term support.