Download - Reflection Paper 2 Deinstitutionalization
Mental Health Overview Dana WalkerInstructor John Mack 2/9/14
Reflection Paper 2 Deinstitutionalization
The word deinstitutionalization conjures up conflicting notions about its efficacy since its
inception in the 1950’s. As Fuller Torrey (1997) said “The magnitude of deinstitutionalization of
the severely mentally ill qualifies it as one of the largest social experiments in American history.”
As we shall see, the “magnitude” of deinstitutionalization carries with it the good, the bad, and the
ugly in regard to reformation on behalf of the mentally ill.
The word deinstitutionalization encompasses, for example, the following hopeful
definitions: to release (a mentally or physically handicapped person) from a hospital, asylum, home,
or other institution with the intention of providing treatment, support, or rehabilitation primarily
through community...;. To remove (care, therapy, etc.) from the confines of an institution by
providing treatment, support, or the like through community facilities...; to free from the
bureaucracy and complex procedures associated with institutions. In other words, at the inception of
deinstitutionalization there was great hope that the mentally ill would be provided adequate
community care, affording them the respect and help they so desperately needed.
The good news is deinstitutionalization aimed to implement care that treated the mentally ill
as worthwhile people who deserve as much respect, dignity, and consideration as any other
American. As Lamb and Bachrach (2001) said “First, it was widely, even passionately, assumed
that community-based care would be intrinsically more humane than hospital-based care. Second, it
was similarly assumed that community-based care would be more therapeutic than hospital-based
care.” Lamb and Bachrach (2001) include impressive statistics regarding deinstitutionalization,
stating that “…in a little more than 40 years the number of occupied state hospital beds in the
United States was reduced from 339 per 100,000 population to 21 per 100,000 on any given day.”
Lamb and Bachrach (2001) go on to say quite positively that “The quality of care for these persons
has improved substantially, and many individuals express much greater satisfaction with their life
circumstances as contrasted with conditions inside psychiatric hospitals.”
Yet for the severely mentally ill, the fall-out from deinstitutionalization created a population
that has not received proper care, especially for those with Schizophrenia and like illnesses, because
the negative outcomes of deinstitutionalization was unforeseeable at the time. As Fuller Torrey
(1997) stated “For a substantial minority, however, deinstitutionalization has been a psychiatric
Titanic. Their lives are virtually devoid of ‘dignity" or ‘integrity of body, mind, and spirit.’ The
‘least restrictive setting’ frequently turns out to be a cardboard box, a jail cell, or a terror-filled
existence plagued by both real and imaginary enemies.” With so many institutions being closed,
there was, and is, not enough community care available to address the unique needs of these people
who cannot function in society without being heavily monitored or institutionalized. These people
either end up living on the streets, or are repeatedly jailed for committing crimes when they
succumb to their illnesses, oftentimes due to them discontinuing their medication.
One such case involved my friend Michael who has Schizophrenia. He cycled through the
King County jail system five times for committing numerous misdemeanors after going off his
medication, because he had no community healthcare access to help keep him stabilized. He lost
his apartment after his second offense, staying in motels between jail stays, rendering him a statistic
of the homeless population. And although at one point his cases were being handled by the Mental
Health Court, which was established to help prevent people with mental illness from being
incarcerated, he still ended up in jail 2 to 3 more times before he was finally admitted to Western
State Hospital. As Lamb and Bachrach (2001) so aptly put it “Many planners who continue to
harbor the hope that we will someday eliminate these facilities increasingly acknowledge the
difficulty of establishing alternative sites where patients can be admitted for intensive, structured
observation or comprehensive care in a hospital-like setting. Thus the problem of homelessness
will not be resolved until the basic underlying problems of the long-term severely mentally ill
population, generally are addressed and a comprehensive and integrated system of care is
established for them.”
In conclusion, it appears that many good things have come out of deinstitutionalization for
those who are less afflicted by mental illness. In turn though, we have a long ways to go in
rendering effective care for the severely mentally ill, for the population who needs the most
intensive care who are still falling through the cracks more than 50 years after deinstitutionalization.
References
Bachrach, L., Lamb, H. R. (2001). Some perspectives on deinstitutionalization [Article].
doi: 10.1176/appi.ps.52.8.1039.
Fuller Torrey, E. (1997). Out of the shadows: confronting America's mental illness crisis.
New York: John Wiley & Sons.
Retrieved from http://dictionary.reference.com/browse/Deinstitutionalization.