Institutionalization and Deinstitutionalization

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For centuries, any discussion or reference to a mental illness was making people increasingly uncomfortable. More often than not, mental afflictions were and still are kept as a dark secret. An unusually big dark secret: the statistics show that, in the US alone, around 46% of the population is diagnosed with a mental illness, of them 27.7% is co-morbid with two or more mental ailments and 17.5% with three or more. It is inevitable that, with almost half of the population being affected, the “secret” will need to be confronted and discussed; the solution to help the affected population will need to be sought; the proverbial “home” for such people will need to be found. Then, the questions arise: where will such “home” be? Would it benefit all concerned parties if such individuals were integrated within or segregated from the society? Can the society afford to segregate them and, what’s more, can the society afford to integrate those that are severely impaired? What impairment will require institutionalization, and what can be treated without resorting to the confinements of the mental health facility? In order to arrive at a weighted conclusion, it seems prudent to examine the history that led to the modern view on institutionalization and its systematic establishment and demise throughout the centuries and the millenniums. 16th century BC Egyptian papyri provided some evidence to the earliest treatments of deceases and behaviour disorders (30). Some of the papyri give a perspective on a treatment, which, more often than not, was reliant on magic and incantations; then, there was minimal differentiation between medicine and magic, with trepanation used as the “cure” for the mental ailment. Back in 400BC, Hippocrates, recognising the importance of the environment, often removed the patient from their families. He was followed by Plato, who made “hospital” provisioning to treat mental cases. Ultimately, these initiatives made the 400BC the inception age of the...
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