Post Closure

The Indiana Consortium for Mental Health Services Research Institute for Social Research at Indiana University published its sixteenth and last public report in March 2005. The report tracked former Central State Hospital patients into the community. The study focused on collecting data of the discharged clients in order to track location, clinical functioning, treatment utilization, special service needs and general challenges. The final report details the status of the 389 Central State Hospital patients between November 1st 2003-October 31st 2004. To access the full public report click here. The following is a summary of the report which contains some of the data graphs published in the report. The following is intended to provide an informational guide as the whereabouts and situational circumstances of former Central State Hospital patients. The report discloses:

“This report does not advocate for a position for or against the decision to close Central State Hospital. Our role is that of an outside, independent evaluator…Because these data reflect only a limited span of these consumer’s community tenure, generalizations regarding long-term trends or outcomes for this population cannot be made. This report speaks only to the discharged patients functioning and adaptation during this period.”

The 389 patients were categorized as those with mental illness (MI) and those who are also afflicted by both mental illness and a developmental disorder (DD).

The study found that out of 389, “the majority continue to reside in semi-independent living apartments (23.1%), private residences (17.0%) and supervised group living settings (9.5%). The remaining clients living in the community are distributed among a variety of settings which include: state-operated facilities (7.5%), nursing homes (4.4%), and licensed room and board homes (2.1%). As of October 31, 2004 eight clients (2.1%) are incarcerated, 27 clients (6.9%) are missing and 95 clients are deceased (24.4%).”

Source: The Central State Hospital Discharge Study Tracking Report - March 2005

Source: The Central State Hospital Discharge Study Tracking Report - March 2005

The study found that patients with mental illness were distributed as follows:

“Figure 1a lists locations, as of October 31, 2004, of patients with a MI diagnosis. Group homes and private residences are providing care for the largest group of MI patients (31.3%). Of the patients living in state-operated facilities, most are residing in Logansport State Hospital (40.9%), Larue Carter Memorial Hospital (40.9%), and Richmond State Hospital (13.6%). The second largest group of MI patients is currently staying in supervised living apartments (13.2%). The remaining MI patients are located in various community settings which include nursing homes (5.3%), and licensed room and board programs (2.6%). Since March 23, 1992, 78 MI patients have died (25.7%) and 25 are missing (8.3%). MI patients have died (25.7%) and 25 are missing (8.3%).”

Patients with developmental disorders and mental illness are distributed as follows:

“ Figure 1b depicts the variety of locations where individuals with a dual diagnosis have been placed. The largest group of DD clients continues to live in semi-independent living programs (58.1%). The second largest group of DD patients is living in private residences (5.8%). As of October 31, 2004, 8.1 percent of DD clients are listed as living in state-operated facilities. Of the DD clients currently living in state-operated facilities the majority live at Madison (28.6%), and an equal percentage live in Richmond State Hospital (22.2%), along with an equal percentage at both Logansport State Hospital, Muscatatuck State Hospital. An additional 14.3% of DD clients reside at Fort Wayne Development Center. The remaining DD patients continue to live in supervised group living facilities (3.5%), a Medicaid waiver home (1.2%) and in a nursing home (1.2%). Since March 23, 1992, 17 (19.8%) DD clients have died."

Source: The Central State Hospital Discharge Study Tracking Report - March 2005

Source: The Central State Hospital Discharge Study Tracking Report - March 2005

The study also evaluated the former Central State Hospital patients using the Global Assessment of Functioning from the American Psychiatric Association developed in 1995. This gives an estimation of “how well clients are doing in the community.” The scale ranges from 1 (Very Poor Mental Health) to 100 (Perfect Mental Health). The consensus among those utilizing the scale is that scores ranging from 35-40 and below are indicators of a necessitated inpatient care while scores ranging from 80 and above are characteristic of people with few mental health problems. Out of the 221 who reported their scores, the median for dates ranging November 1st 2003 to October 31st 2004 was a 43.8. There were fluctuations in the data per month, as it was required for mental health providers to report monthly. The highest score was during the month of April 2004 with a high of 44.5 and the lowest was in January of 2004 at 43.1. The group that experienced the lower scores during this period were reported to be residents of nursing homes. The breakdown of the Global Assessment of Functioning scores broken down by living arrangement is graphed in Figure 3.

Other outcomes

Out of the 389, only 35 of them reported that they are living in the community and not receiving services. These 35 clients are listed as missing by their mental health service providers.
According to the study, the former residents who were accounted for were found to be relatively free from health issues. Out of the 221 clients who are living within the community, only 46 reported having health issues. Health issues for the majority were minor such as, arthritis, reflux disease, obesity, side-effects from medication, high cholesterol, hypertension, and respiratory problems.
In contrast, few were reported as being afflicted by serious issues such as cancer, lung disease, pneumonia, renal failure, diabetes, osteoporosis, broken bones, stroke and congestive heart failure. All of these individuals were found to be receiving care for their current health issues.
As of October 31st 2004, ninety-five of the former Central State Hospital patients have died—the average age of death was calculated as 57. These deaths were attributed to cardiovascular disease and heart problems in addition to cancer and respiratory failure.
Out of the 221 patients who were within the community treatment setting, only 26 were admitted into an acute care psychiatric hospital between the dates of November 1st 2003 and October 31st 2004. Their stays varied—12 of these patients averaged 2.9 admissions over the twelve month period with an average stay of 2.6 days.
Through the same period of time, clinicians reported minimal contact with law enforcement. Only 17 of the former patients had issues with law enforcement during the twelve month period. According to the study, public intoxication, assault and violation of probation were among the reasons for contact. Only 5 clients spent time in jail which averaged at 15.4 days.

The study, once again, is not to be taken as an account on for or against the closure of the Central State Hospital and it is rather purely informational.