Deinstitutionalization: policy, practice, and social implications

Deinstitutionalization is a rather awkward term that is used to describe the phenomenon whereby people who were once cared for the long-term in hospitals and other institutions are being released into the local communities. This includes both people who are mentally handicapped as well as the severely mentally ill. The goals of such programs is to improve conditions within psychiatric hospitals. Community health centers were at that time set up to provide inpatient care services. In addition, they included day care as well as out patient clinics and emergency education and services. While the theory sounds good, the practice very often means that families and individuals are left to cope with the difficult and often dangerous situations, lacking adequate support. Many hospitals have been closed altogether. These patients have been transferred to community-based mental health clinics, resulting in the dissipation of patients over a wide variety of health care institutions, many greatly overstretched. The information about the effects of this deinstitutionalization upon the criminal justice system is mixed. However, there is a greatly increasing the amount of mentally handicapped individuals amongst the prison population. For this reason, there is a need for the expansion of mental-health services among the prison population. Also, mental health courts promise to provide relief.

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Deinstitutionalization was first instituted in 1955 with the widespread introduction of Thorazine. This was history's first effective antipsychotic medication. It received its major impetus some 10 years later with the creation of federal Medicaid and Medicare. Deinstitutionalization is made up of two parts:

1. The moving of the severely mentally ill out of the state institutions.

2. The closing of part or all of those institutions ("PBS.org").

Due to the magnitude of the deinstitutionalization program of severely mentally ill patients qualifies it as possible one of the largest social experiments in Unite States history. There were 558,239 severely mentally ill patients by 1955 in the nation's public psychiatric hospitals. By 1994, this total number had been reduced by 486,620 patients, to 71,619 (ibid).

Deinstitutionalization was signed into law in the form of the Community Mental Health Centers Acts by John F. Kennedy on October 31, 1963 when he established community health centers. J.F.K. intended that the mentally ill could leave mental health hospitals and move them into a home that was administered by the local states where they were from. With the discovery of brand new medications, it was much easier for people to be deinstitutionalized. Then with the help of social workers and psychiatric rehabilitation, patients gain their personal freedom and independence. By reducing the size of state mental health hospitals, the ideology was very popular with Liberals due to the fact that the mental health patients received their freedom. It was also approved as well by conservatives of both the major political parties because of the substantial amount of funds that would be undoubtedly saved by cutting the national mental health budget (Lamb, Weinberger, and Gross 107-109).

There are additionally several other aspects of this institutionalism that were not recognized in the very early stages of deinstitutionalization. First, the observations of patients that spent a substantial amount of time in a mental hospital prove one that develops institutionalism. This is a psychological syndrome characterized by a lack of initiative, withdrawal, apathy, submissiveness to authority and excessive dependence upon the mental institution. It has also been discovered that some of these psychological reactions were caused by external stimulation and are the qualities of the disease itself. One of the most important factors, is what left these mentally ill people unable to work, cope with community, support themselves and to ideally make them feel somewhat like a member of the local community. Particularly hard hit are people of color. Racial minorities not only make up a disproportionate amount of the population of the homeless, but also in jails (Deas-Nesmith, and McLeod-Bryant 1036).

Generally, it has been reported that from 10 to 15% of the persons in local jails and federal and state prisons are suffering from severe mental illnesses. The magnitude of this problem can also be seen when we multiply the percentages of mentally ill people in prisons jails by the number of inmates. To wit, in 2001, there were 1,980,000 adults who were incarcerated in the jails and the state and federal prisons in the United States. This way, even a small percent of such large populations represents a huge number of mentally ill persons in prisons and prisons. The source for this significant increase in the population of mentally ill persons in the prison population is most likely to be from the deinstitutionalization of the mentally ill and also their release into the general community population (ibid, 109-110).

However, the information regarding the impact of deinstitutionalization upon the penal population. According to statistics published by the National Coalition for the Homeless, that despite the disproportionate number of the mentally ill among the homeless population, the growth in the population of the homeless is not attributable to the release of very seriously mentally ill people from mental health institutions. Most patients were released from the mental hospitals in the 1950s and 1960s. However, the vast increases in homelessness did not happen until the 1980s. This is when incomes and housing options for those living on the margins of society began to diminish rapidly. Additionally, a new wave of deinstitutionalization and denial of services or unplanned and premature discharge brought about by the managed care arrangements might be contribute to the continued presence of seriously mentally ill people in the homeless population. Despite disproportionate numbers of mentally ill people among the homeless, the continued growth in homelessness is not to be attributed to the release of such seriously mentally ill people from hospitals ("National Coalition for the Homeless").

While the PBS documentary we quoted above lays the blame on deinstitutionalization for the increase in the mentally ill population of the prison and jails, that is it is attributing the increase in the mentally ill to this deinstitutionalization. However, it brings up an important point, namely that the results of deinstitutionalization vs. The increase in the prison differed by state. Also PBS quotes some direct observations by correction officials and psychiatrists also support a causal relationship between deinstitutionalization and the growing number of former mental patients in prisons and jails. Also, they quote the reasons for the increases. In a 1992 Public Citizen survey, investigators also found that some 29% of the jails also sometimes incarcerate persons who do not have not against them. They are merely simply waiting for psychiatric evaluation, transportation to a psychiatric hospital, or the availability of a psychiatric hospital bed. Such imprisonment is done under the state laws that permitted the emergency detentions of individuals that were suspected of being mentally ill. This is especially common in rural states such as Mississippi, Kentucky, Montana, Alaska, Wyoming, and New Mexico. Also, the PBS study quotes figures that the most severely mentally ill people in jails are there because they have been charged with only a misdemeanor. Edwin Valdiserri completed a 1983 study where he reported that mentally ill prison inmates were "four times more likely to have been incarcerated for less serious charges such as disorderly conduct and threats" compared with nonmentally ill inmates. The PBS study sees the need for expanding metal health services extensively for jail inmates ("PBS.org").

What is to be done?

The question of what is to be done is a question which is on many minds now due to hard economic times. No matter what the validity of the connection of deinstitutionalization and the incarceration of the mentally ill, the number of available options are at best very limited. However, an innovative approach has been contemplated of late in several states and also by the federal government: a mental health court system. This is precisely the solution that is being foreseen in Ohio where the Advisory Committee on Mental Illness and the Courts (ACMIC), which oversaw development of mental health courts and specialized training for more than 4,500 law enforcement officers, will evolve into the Attorney General's Task Force on Criminal Justice and Mental Illness. This will allow further expansion beyond the present court system. It will also affiliate the broader efforts by officials to keep the mentally ill from becoming criminal defendants. This will included some greater funding for the efforts ("Youngstown News"). Also, a mental health court system is slowly coming onto the radar screen of the United States federal government. The Bureau of Justice Assistance (BJA) funds a number of Mental Health Courts around the country ("Bureau of Justice Assistance").