Therapy: Deinsitutionalization

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The deinsitutionalization movement began with the recognition that hospitalization is a major step to take: It removes people from their jobs, from their patterns of daily life, and from the social support of their family and friends. It is also a major expenditure-for the individual, the family, and, increasingly, the medical plan. For all these reasons, ”reentry” into society is difficult following hospitalization.

Recognizing these social and financial costs of hospitalization some mental health policy experts urged that many, perhaps most, mental hospital patients be discharged. The hope was that these people would be treated in other settings, particularly community mental health centers. The concept of community health center appeared in the 1960s, partly in response to dissatisfaction with mental institutions. The community mental health movement was formed to deal with problems on a local level, if possible before hospitalization was needed. Services at community mental health centers were tailored to the needs of the local populaton and might include ongoing psychotherapty hotline phones so that anyone with a problem could fmd a ready listener public education on problems like drug abuse and active participation in projects such as upgrading poor housing that might affect the emotional stability of the community.

For many deinsitutionalization patients, the commune mental health center along with help from their families and the continued use of psychoactive drugs worked adequately enough These people recentered normal life with some success. But for many others deinsitutionalization worked poorly. To begin with, many discharged patients had no homes or communities to go to. Other discharged patients did not always get the help they needed to function successfully outside the hospital. Many for instance lost access to the medications that had moderated their abnormal behaviors. There is one unfortunate effect of deinsitutionalization almost every reader of this page is likely to be aware of-the growing number of homeless street people in towns and large cities. Some of these people who stand on corners shouting their anger or carry on lengthy conversations with imaginary others are discharged mental patients.

Thus, the deinsitutionalization movement has not been well implemented. Funding for centers has often been inadequate many planned centers were never built, and of those built, many were inadequately staffed. More subtle problems also occurred. For example, the coordination between mental hospital and community mental health center was often poor; patients left the jurisdiction of one without clearly falling under the cure of the other. For these and other reasons it is fair to say that our mental health care delivery system” is not working well.

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