Deinstitutionalization

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Deinstitutionalization
Enjoli Mitchell
Metropolitan Community College
HMSV 2120
Social Services Policy
Dr. Bob Dresser

There is an agreement that about 2.8% of the US adult population suffers from severe mental illness. The most severely disabled have been forgotten not only by society, but by most mental health advocates, policy experts and care providers. Deinstitutionalization is the name given to the policy of moving severely mentally ill patients out of large state institutions and then closing the institutions as a whole or partially. Deinstitutionalization is a multifunctional process to be viewed in a parallel way with the existing unmet socioeconomical needs of the persons to be discharged in the community and the development of a system of care alternatives (Mechanic 1990, Madianos 2002). The goal of deinstitutionalization is that people who suffer day to day with mental illness could lead a more normal life than living day to day in an institution. The movement was designed to avoid inadequate hospitals, promote socialization, and to reduce the cost of treatment. Many problems developed from this policy. The discharged individuals from public psychiatric hospitals were not ensured the medication and rehabilitation services necessary for them to live independently within the community. Many of the mentally ill patients were left homeless in the streets. Some of the discharged patients displayed unpredictable and violent behaviors and lacked direction within the community. A multitude of mentally ill patients ended up incarcerated or sent to emergency rooms. This placed a huge burden on the jail systems. Communities were not the only ones to suffer. Those who suffered with mental illness were the ones who were ultimately affected. The stereotypes attached to mental illness were enough for some to not get the appropriate help that they needed. Often times, the communities would not get involved, discarding those who suffer with mental illness. Commonly, those with mental disorders do not have the means or abilities to take care of themselves, relying heavily on state or local centers for help. If the centers are not there to help, where are they to go? Because of deinstitutionalization, there are those, who live on the streets, are put in jails, or are left to fight for their lives alone. In the United States in the nineteenth century, hospitals were built to house and care for people with chronic illness, and mental health care was a local responsibility. Individual states assumed primary responsibilities for mental hospitals beginning in 1890. In the first part of the twentieth century many patients received custodial care in state hospitals. Custodial care means care in which the patient is watched and protected, but a cure is not sought. After the National Institutes of Mental Health was founded, new psychiatric medications were developed and introduced into state mental hospitals beginning in 1955. The new medicines brought hope. President John F. Kennedy's 1963 Community Mental Health Centers Act promoted and sped up the trend toward deinstitutionalization with the establishment of a network of community health centers. In the 1960s, when Medicare and Medicaid were introduced, the federal government took on a share of responsibility for mental health care costs. That trend continued into the 1970s with the placement of the Supplemental Security Income program in 1974. State governments promoted and helped accelerate deinstitutionalization, especially of the elderly. Deinstitutionalization is directly linked with the state and the financial support of the program. In several countries the shift from the welfare state to the caused dramatic negative impact in the organization of the delivery of effective and adequate mental health care for the unstable low class mentally ill individuals. As hospitalization costs increased, both the federal and state governments were motivated to find less...
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