Deinstitutionalization
Deinstitutionalization is a significant policy shift that emerged in the United States following World War II, aimed at transforming the care of individuals with mental illnesses. This approach evolved in response to advancements in antipsychotic treatments and a growing recognition of patients' rights, leading to the release of long-term patients from state hospitals into community-based mental health programs. The underlying philosophy emphasized dignity, freedom, and empowerment for individuals previously confined in institutions where they often faced overcrowding, abuse, and stigma.
While deinstitutionalization aimed to reintegrate patients into society, offering them support through outpatient services and public housing, the execution varied widely across states. Many individuals were discharged without adequate preparation or support, resulting in challenges such as increased rates of depression, addiction, and even homelessness. Critics argue that the inadequacies of community services have led to a troubling cycle where many former patients end up incarcerated, effectively replacing state hospitals with prisons as new custodial settings.
Despite its noble intentions, the deinstitutionalization movement has highlighted the need for comprehensive community mental health systems to provide stable living conditions and essential support for individuals transitioning from institutional care.
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Deinstitutionalization
No national public health care policy in the second half of the twentieth century better reflected the changing cultural perception of patients in mental hospitals than the policy of deinstitutionalization. Deinstitutionalization was among the most daring—and controversial—social engineering experiments in the United States after World War II. Following the development of antipsychotic drugs in the 1950s, which effectively treated the most extreme manifestations of mental illness, and the social rights movements of the 1960s, deinstitutionalization called for long-term patients confined to state hospitals to be released and serviced by community-based mental health treatment programs and to live in low-cost public housing, ideally staffed by experienced counselors. Many state-run mental institutions, which had been operating under limited budgets and subjecting patients to substandard care, then shut their doors.
Overview
Before World War II, state hospitals isolated mental patients from the community; their illnesses were perceived as incurable and it was thought that patients were prone to violence. After the war, however, many decorated soldiers continued to suffer psychological trauma, and the medical community reexamined their perceptions. They began recommending short-term outpatient treatment over long-term custodial care. Reintegrating mental patients into the community would, in turn, help counter the effects of long-term confinement, which included loneliness, low self-esteem, and feelings of helplessness. Patients would regain their dignity, sense of freedom, and empowerment. Then mental hospitals, many of which were overcrowded and subjected patients to various forms of abuse, could be partially or completely closed. Offering treatment services within the community began to destigmatize mental illness and allowed patients to become active members of the communities from which they had long been restricted. Economic incentives for the state was a major factor in deinstitutionalization. The release of treatable mental health patients from state hospitals made them essentially wards of the federal government, and the burden of ensuring counseling services, drug regimens, and support groups shifted. State hospitals were then able to reallocate their limited monies by cutting the available beds and focusing on patients who required long-term custodial care.
Over the decades, deinstitutionalization has worked for millions, but support services for discharged patients have varied from state to state. Many patients were released without proper preparation and lacked a strong support network; they became prone to extreme depression, suicidal ideations, and alcohol and drug addiction. Because the necessary community services were seldom coordinated sufficiently to provide a sustaining network, a distressing number of patients often returned again and again for short-term hospitalization. Others turned to crime, or were victims of crime, as they struggled to maintain residency and often ended up living in the street, thus vastly increasing the homeless population nationwide. Critics of deinstitutionalization maintain that the prison system has unfairly become the new alternative custodial care provider. More problematically, estimates indicate that the broader health care system realized very little economic benefit from deinstitutionalization. Experts have advocated a broad enhancement of the community mental health system to address the basic needs of those deinstitutionalized by ensuring they have stable living conditions, counseling support, low-cost medication, and steady employment.
Bibliography
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