History Part Tres-Deinstitutionalization

I’m not going to go really in depth, because a simple google search will tell you a lot about the controversies surrounding Deinstitutionalization. Here I’m giving a very simple summary:


This was the process by which asylums were replaced with community care programs. It had it’s roots in the late 1920’s but it wasn’t until the 1950’s that it became a popular idea for the mental health care standard.

Basically, as psychological drugs were developed, rates of recovery rose. Health care was becoming privatized and less patients were entering hospitals. There was a very large public push to get as many patients out as possible, especially since outpatient care was much less expensive than staying in a hospital, and the public opinion was that almost anyone could be cured with the right drug.

In 1963, JFK passed the Community Mental Health Act. The act provided federal funds to community based health centers. The idea was to provide the mentally ill with options in regards to care, but it had the opposite of intended effect—many of the state hospitals were shut down by states due to their high cost—and because there were supposed to be federal funds, never replaced the hospitals with state programs leaving many patients with nowhere to go for care.

In Northampton, many of the patients complained and brought a class-action suit against the governor of Massachusetts, which resulted in the “consent decree” which required that the centers be built. The plan took 14 years to implement and by the time it was finished the hospital was down to the 50 most affected patients.

Some good links for more info include:

http://www.smith.edu/nsh/dein.html

http://en.wikipedia.org/wiki/Deinstitutionalisation

And for my fellow students in Psychology 380, the first chapter of the book describes much of this.

Now that we’ve gone through the history and know that things weren’t always as they are today…how does it apply to the current issue of homelessness, of which this blog is supposed to address?

Deinstitutionalization was supposed to address some of the inhumanity experienced in the overcrowded state hospitals. It was to release the states of the expense of caring for patients who, with the help of modern medicine, were capable of life outside the institutions. It was intended to create an environment where hospitalization was temporary and hope for recovery was high. Unfortunately, this ideal depended very heavily on community health centers—many of which were not built and the ones that exist do not meet current demands. Combined with the privatization of healthcare, many people cannot afford to be treated for mental illness.

Sources differ widely on the percent of homeless who suffer from mental illness, but estimates range from 17-60% with 30% being the number most often cited. It seems to depend on the area studied. Regardless of which statistic is used, the number of homeless with mental illness is much greater than the general population. An individual on the poverty like with an illness is much more likely to become homeless than one who is not.

This is not to say that deinstitutionalization was responsible for these statistics—in fact, the number of homeless rose sharply long after much of the plan had already gone into effect. However, the lack of funding for projects and the closing of state hospitals has led to fewer options in treatment. There is some debate as to it's effects, but that is more than I can cover. I will explore more of the statistics, causes and concerns regarding homelessness and mental illness in my next post.