Deinstitutionalization? Where Have All the People Gone?

Abstract

Although there is broad consensus that the state psychiatric hospital population drastically declined over the past five decades, the destination and well-being of people with serious mental illness (SMI) have been in greater doubt. In this article, we examine the aftermath of the deinstitutionalization movement. We begin with a brief historical overview of the move away from state hospitals, followed by an examination of where people with SMI currently reside and receive treatment. Next, we review recent trends reflecting access to treatment and level of community integration among this population. Evidence suggests the current decentralized mental health care system has generally benefited middle-class individuals with less severe disorders; those with serious and persistent mental illness, with the greatest need, often fare the worst. We conclude with several questions warranting further attention, including how deinstitutionalization can be defined and how barriers to community integration may be addressed.

Psychiatric patients' satisfaction in the therapeutic residence services: A positive experience of psychiatric deinstitutionalization

“…Davis, Fulginiti, Kriegel and Brekke (2012) indicated that the current U.S. decentralized community-based model of mental health care has generally benefited middle-class individuals with less severe disorders, while those with serious and persistent mental illness, with the greatest need, often fare the worst -a statement backed up by Pollack (2013). Underfunding by local and federal governments is reported by many authors (Davis et al, 2012;Pollack, 2013;Yohanna, 2013) as a probable cause of this limited success.…”

“Forever Children” and Autonomous Citizens: Comparing the Deinstitutionalizations of Psychiatric Patients and Developmentally Disabled Individuals in the United States

“…The relatively younger schizophrenics, who were discharged into the "community," received only treatment, but no care (Scull, 1984;Bachrach, 1976;Bassuk & Gerson, 1978). This model worked for some, if their problems were not too severe; if their illness was episodic; and if they had medical insurance, since Federal funding for the CMHCs dried up over time (Davis et al, 2012). For the large group of poor, chronic, severely disabled, however, this model proved a vicious circle.…”

What Factors Influence the Decision to Share Suicidal Thoughts? A Multilevel Social Network Analysis of Disclosure Among Individuals with Serious Mental Illness

“…First, no known studies provide descriptive information on the patterns of suicidal disclosure among individuals with SMI engaged in community‐based psychiatric treatment. Not only are individuals with SMI at increased risk for suicidal outcomes, they are increasingly receiving care in less restrictive settings (Davis, Fulginiti, Kriegel, & Brekke, ), where disclosure may be even more critical to suicide risk management. Second, several individual‐level factors found to be central to disclosure of other stigmatized statuses, such as social support and perceived stigma, have not been explored in relation to suicidal disclosure.…”