Alternative treatment programs: The psychiatric continuum of care

Many of the components of the continuum originated in legislation that created the community mental health centers. The continuum grew in breadth and depth with the arrival of managed care because it offered less expensive ways to satisfy patient needs. Over the past decade, days spent in hospital have decreased from more than 100 per thousand individuals in some health plans to less than 20 for the same populations. Greatly reduced rates of admission and shortened lengths of stay made this decrease possible. But simply being quicker and cheaper is not good enough. To fulfill their promise, the components of the continuum and the larger delivery systems must provide care that is of superior quality and outcome. An important next step in the evolution of the continuum will be to generate the data that will make it possible to evaluate program performance, compare treatment alternatives, and usher in an era of evidence-based mental health care.