This is the 2007 version. Click here for the 2017 chapter 12 table of contents.

Deinstitutionalization

Concern for the legal rights of people committed to mental institutions led to a radical shift of public policy in America. These changes made it much harder to keep people in mental institutions involuntarily. This became known as the deinstitutionalization movement. "Deinstitutionalization" refers to the release of many former mental patients, formerly housed in mental hospitals, to the outside world.

What was the deinstitutionalization movement, and what were some of the factors that caused it?

There were several reasons why the deinstitutionalization movement spread through the United States and Canada and many other countries. Scholars like Thomas Szasz argued that mental illness was unjust if a person had not proven dangerous to others. Government panels projected excessive public expenditures if the populations of mental hospitals continued to grow. Critics argued that hospitals actually harmed patients rather than helping them, forcing them into a dependent role and allowing them to forget how to cope in the outside world. New psychiatric drugs allowed many patients to live successfully outside hospitals, especially if they could be given supervised care.

Deinstitutionalization was implemented as a legal policy in many states and provinces. New laws declared that people could not be hospitalized against their will unless they were an obvious threat to others. Suddenly many former mental patients were free to leave the hospital, for better or for worse, until they were proven dangerous. If they managed to live on their own without getting into trouble with the law, they could stay free.

What problems did deinstitutionalization create?

Unfortunately, many people were released into urban areas where they could not find adequate food or shelter. The result was a sudden increase in the number of homeless people in the 1970s and 1980s. Mental patients seemed to exchange one form of misery for another. Many of the newly released former mental patients ended up being incarcerated again, this time in a jail instead of a mental hospital. Often they could not follow the rules of society and were arrested for breaking laws, or their peculiar mannerisms led to confrontations with law enforcement officials. Northwestern University psychiatry professor Linda Teplin studied this problem for decades. She found, for example, that inmates of the Cook County jail in Chicago had rates of mental illness two to four times higher than the general population.

Teplin found 9 percent of male inmates and 18.5 percent of females had serious disorders, like schizophrenia, proportions she described as huge. She said the female figure was higher because "only the most messed-up women end up in jail, the drug users and prostitutes," and criminal activity is more widespread among men. (Karl, 1999)

What was the largest "de facto mental hospital" in the United States, in 1990?

A report released in 1990 declared that the Los Angeles Country Jail, with an estimated 3,600 inmates who were seriously mental ill, qualified as the largest "de facto mental hospital" in the United States. This was the consequence of giving seriously mentally disordered people both freedom and responsibility, as Szasz advocated 30 years earlier. If they could not play by the rules, they lost their freedom again.

Not all homeless people are former mental patients, and not all of them have mental or behavioral problems. However, many of them do suffer from harmful dysfunctions. After reviewing different sources of data, Fischer and Breakey (1991) concluded that alcoholism was "the most pervasive health problem of the homeless," affecting about 60% of men who were homeless and about 30% of the women. In addition, about two-thirds of the homeless had some other identifiable disorder such as schizophrenia, depression, or antisocial personality (all described in this chapter).

Homeless people themselves tended to deny that mental illness was a factor in their situation. In a 1986 study, only 3% of homeless people in Los Angeles blamed their first episode of homelessness on "psychological problems." In a 1988 study, only 3% of homeless people in Boston agreed that emotional problems contributed to homelessness.


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