Foundations for managing state mental health system performance: The relationships among community program expenditure, poverty, and state hospital bed use

A case study of the pragmatic paradigm in evaluation research is presented. Two assumptions of a state mental health system were tested: that areas of high poverty are a high priority for the funding of public mental health services and that the greater the investment in community services, the lower the use of state hospital beds would be. High poverty areas were found to be associated with both low expenditure per capita in poverty and low rates of state hospital bed use. Conversely, low poverty areas with high expenditure per capita in poverty were associated with the highest rates of state hospital bed use. No immediate impact of the study was apparent except awareness that the high volume of state hospital bed use in some high-poverty planning areas represented not overuse but underuse relative to rates of poverty and community service expenditure.