Deinstitutionalization In Healthcare

This book analyzes the negative aspects of deinstitutionalization and disproves some of the myths surrounding it. It is a reliable source because the author is a social worker and has worked in every type of institution discussed in the book.(S)

Institutionalization in the United States (per 100,000 adults). 2007. www.newyorktimes.com, New York. Web. 26 Feb 2013.

In the video, “The New Asylums”, it demonstrated how deinstitutionalization has left thousands of mentally ill patients in the hands of the prison system. As the mental health hospitals closed down, the police department and prison system has become responsible for the mentally ill people that are on the streets. There was a firm point made about the release of mentally ill patients- “When hundreds of thousands of mentally ill are released, they do not magically become healthy. They went to the streets, became homeless, and turned to a system that cannot say no.” The video also stated that today, there are nearly 500,000 mentally ill people being held in jails and prisons throughout the country. Furthermore, there was no safety net for those

Many years ago, mental illness was viewed as a demonic possession or a religious punishment. In the 18th century, the attitudes towards mental illness were negative and persistent. This negativity leads to the stigmatization and confinement of those who were mentally ill. The mentally ill were sent to mental hospitals that were unhealthy and dangerous. A push in the mid 1950s for deinstitutionalization began because of activists lobbying for change. Dorothea Dix was one of these activists that helped push for change. The change called for more community oriented care rather than asylum based care. The Community Mental Health Centers Act of 1963 closed state psychiatric hospitals throughout the United States. "Only individuals who posed an imminent danger to themselves or someone else could be committed to state psychiatric hospitals" (A Brief History of Mental Illness and the U.S. Mental Health Care System). Deinstitutionalization meant to improve quality of life and treatment for those who are mentally ill. This would hopefully result in the mentally ill receiving treatment so they could live more independently. The hope was that community mental health programs would provide this treatment but sadly there was not sufficient or ongoing funding to meet the growing demand for these programs. Budgets for mental hospitals were reduced but there was no increase for the community based programs. Many mentally ill individuals have been moved to nursing homes or other residential

Containing individuals in an institution when they have the ability to live in the community, places severe restrictions on an individual’s ability to interact with the community. When individuals who could benefit from a community placement remain institutionalized, it causes a false perception that all people in institutions are unable to function in a community setting. The

This study is considered causal-comparative. The participants were questioned within 7 days of arriving to a residential program after their consent was given. Each participant was paid $10 to provide demographic information

The community-based mental health programs are not only inadequate in relation to numbers, but also underfunded (Unite for Sight.org, 2013). According to Martin (1995), we live in a society that is increasingly becoming conscious of an excessive tax burden. Tax burden, on the other hand, provides for the realization of just how deinstitutionalization is directly related to politics and public policy. The pubic in America who account for the electorate, have a significant say in how policy is affected. To this extent the assumption in relation to deinstitutionalization is that due to increased public outcry in regards to taxation, the both federal and state governments have over the years been forced to cut down spending on some items in the recurring budget in order to free up additional funds. According to Treatment Advocacy Center (2011), the federal government in 1965 surgically excluded the payment of Medicaid for patients institutionalized in state psychiatric and other mental disorders institutions. The goals of this action, according to Treatment Advocacy Center (2011) was to foster deinstitutionalization, and the wading of care costs to sates, viewing them as largely responsible for mental care.

During the 1950s, people who had a disability had two options of housing which included living with their families or living in an institution. However, families did not receive much support since most public welfare services were used towards institutional care, such as mental hospitals and orphanages. Throughout the 1960s there were movements to deinstitutionalize, which at that time basically led to smaller institutions. The 1970s allowed for even smaller community-based residential services that were typically designed for not more than 12 people that were similar in terms of age, independence, or ability. Even though different funding was available, many standards were violated in most of the institutions. Throughout the 70s there were movements to close state institutions and provide more community residential services as well as family support. During the 1980s groundwork for families was laid to expand their control of the nature of the support they received and more options were available to help out with living outside an institution. People with developmental disabilities began to gain increased support to having homes of their own during the 1990s and funded had dramatically increased to over $735 for family support programs in 1998. In 2001 the federal government began a new freedom initiative to “remove barriers to community living for people of all ages with disabilities and long-term illness.” In 2011 the decision that the isolation of people with

The conditions of psychiatric hospitals were poorly maintained yet again. From the late 1800s until the mid-1900s, the conditions of these institutions were hit or miss. Despite the rising population of those in need of mental health treatment, conditions were deteriorating across the board. This pushed in the deinstitutionalization movement (Nevid, Rathus, & Green, 2014). This was a push to remove patients from state-run hospitals into a more community-based treatment center. In most cases today, there are treatment plans in place depending upon the severity of the disorder an individual may be suffering from. It’s more about treating an individual with any variety of modern techniques or therapies and trying to reintegrate them into society rather than a lifelong stay in an institution. Deinstitutionalization didn’t work the way it was intended. After it was put into place there was a rise in the homeless population and different programs that were supposed to be put into place didn’t live up to

Today, it seems almost incomprehensible that so many people with serious mental illnesses reside in prisons instead of receiving treatment. Over a century and a half ago, reform advocates like Dorothea Dix campaigned for prison reform, urging lawmakers to house the mentally ill in hospitals rather than in prisons. The efforts undertaken by Dix and other like-minded reformers were successful: from around 1870 to 1970, most of the United States’ mentally ill population was housed in hospitals rather than in prisons. Considering reformers made great strides in improving this situation over a century and a half ago. Granted, mental hospitals in the late 19th and early 20th century were often badly run and critically flawed, but rather than pushing for reform of these hospitals, many politicians lobbied for them to close their doors, switching instead to a community-based system for treating the mentally ill. Although deinstitutionalization was originally understood as a humane way to offer more suitable services to the mentally ill in community-based settings, some politicians seized upon it as a way to save money by shutting down institutions without providing any meaningful treatment alternatives. This callousness has created a one-way road to prison for massive numbers of impaired individuals and the inhumane warehousing of thousands of mentally ill people. Nevertheless, there are things that can be done to lower the rate mentally ill persons are being incarcerated. Such

With states closing many of its mental facilities in the communities, there were a lot of people in need of outpatient care who fell through the cracks of the system and ended up in prison. Prison is where many of them died from inadequate treatment. Prisons were suddenly receiving inmates with the following types of mental illnesses: Schizophrenia, bipolar, and deep depressions. These prisons just did not provide these inmates with any medication during their incarceration. Because the community based health services is lacking, and patients aren’t receiving sufficient outpatient care, it makes the effectiveness of deinstitutionalization a serious problem. Without the availability of 24/7 psychiatric services that are well structured, I believe that deinstitutionalization is what is accounting for the increase of the mentally ill inmates in the correctional facility.

In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the

In an effort to transform the public mental health system, in 1963, President Kennedy proposed the Community Mental Health Act. It was the first among several federal initiatives to create a community mental health care system. Once the act was ratified, there was an intense deterioration in institutionalization, otherwise known as “deinstitutionalization”, and by 1980 there was a 75% declined of the inpatient population at many public psychiatric hospitals. In 2000, there was less than 10% of the public institutionalized just fifty years earlier. In 2009, there was even a more dramatic shift among children and adolescence whereby there was a 98% decline in

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

The author illustrates some of the first state hospitals, such as Creedmoor and Bronx State. Attempting to sustain the professed values of asylums, Sacks (2009) drew attention to interventions that was then helpful that are currently utilized today. Sacks (2009) raised micro and macro issues that linger controversy of whether deinstitutionalization was more beneficial than the upkeep of asylums for the mentally ill.