Staff also indicated that many important policies that affected clients were made by MDMH or were established in Missouri law.
At the hospital, it was clear to both staff and clients that clients' final decision-making authority rested with the hospital's executive staff, or, in some cases, with the MDMH director or the Missouri legislature.
7 Some important policies that affect clients are made at the MDMH or legislative levels.
This study included 188 of the 200 patients hospitalized in one of four MDMH long-term psychiatric hospitals on July 1, 1995.
This study was a secondary analysis of data collected in conjunction with an annual statewide survey of patients in all four MDMH long-term psychiatric hospitals.
Among the 74 discharged patients, 11 patients (15 percent) were rehospitalized in a MDMH long-term psychiatric hospital within six months of the release date.
In most analyses it was calculated as the number of years from the date of admission from the community into any one of the four MDMH long-term hospitals to the survey date.
All three types of forensic patients defined by Missouri statute were found in the four MDMH long-term public psychiatric hospitals.
Regardless of degree of integration of forensic and voluntary patients, all four MDMH psychiatric hospitals were in the process of shifting from custodial and psychiatric treatment models to a psychosocial rehabilitation model for voluntary and NGRI patients (Linhorst, 1995b).
These areas were selected because of their inclusion in the cross-sectional survey of all inpatients residing in the four MDMH long-term public psychiatric hospitals on July 1, 1995, and because we believe they present a comprehensive clinical picture of the patients.
The MDMH defines three security levels: (1) maximum security, (2) minimum security with locked wards, and (3) minimum security with open wards or cottages on hospital grounds.
According to an unpublished MDMH outcomes study (Vieweg, 1995), the mean GAF score of NGRI patients was not statistically different from that of a sample of MDMH clients residing in the community, whereas the mean GAF score of long-term voluntary patients was similar to patients in acute care public psychiatric hospitals.