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.