Deinstitutionalisation
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Deinstitutionalisation usually refers to the process of discharging long term patients from psychiatric hospitals and other long-term facilities, so that they can live in the general community.
The idea took hold in various countries in the 1950s and 1960s Scherl D.J., Macht L.B., "Deinstitutionalization in the absence of consensus", Hospital and Community Psychiatry, 1979 Sep;30(9):599-604 [link], possibly as part of the anti-psychiatry movement, which saw incarceration of the mentally ill as often unnecessary and/or inhumane. It was also introduced as a cost saving measure, or a sensible alternative to state hospitals, as long as the discharged patients were serviced in their new community health centers and were able to take their necessary medications. New psychiatric medications were thought to have made it also possible to release this population into the community safely. Rochefort, D.A., "Origins of the 'Third psychiatric revolution': the Community Mental Health Centers Act of 1963", Journal of Health Politics, Policy and Law, 1984 Spring;9(1):1-30. [link]
A significant catalyst in the United States was the Community Mental Health Act of 1963.
It has been used by some governments and their agencies to save money by closing down, scaling back or merging psychiatric inpatient units. One possible result of this could be that patients who need to, and often want to be admitted to hospital cannot find beds or are discharged before they have fully recovered. Community support services for the mentally ill are a partial solution to this problem, providing care without institutionalisation where possible, although this too can become problematic as it is not necessarily a cheaper option or always an effective one.
Deinstitutionalisation is thought to have caused and resulted in widespread homelessness in the United States and some other countries. Feldman, S., "Out of the hospital, onto the streets: the overselling of benevolence", Hastings Center Report, 1983 Jun;13(3):5-7. [link]
See also
References
Bibliography
- Borus, J.F., "Sounding Board. Deinstitutionalization of the chronically mentally ill", New England Journal of Medicine, 1981 Aug 6;305(6):339-42. [link]
- Pepper, B., Ryglewicz, H., "The role of the state hospital: a new mandate for a new era", Psychiatric Quarterly, 1985 Fall-Winter;57(3-4):230-57. [link]
- Sharfstein, S.S., "Community mental health centers: returning to basics", American Journal of Psychiatry. 1979 Aug;136(8):1077-9. [link]
- Torrey, E. Fuller, M.D. and Zdanowicz, Mary, Esq., "Why deinstitutionalization turned deadly", Oped, The Wall Street Journal, August 4, 1998. [link]
- Torrey, E. Fuller, M.D. and Zdanowicz, Mary, Esq., "Deinstitutionalization hasn’t worked: 'We have lost effectively 93 percent of our state psychiatric hospital beds since 1955'", Oped, The Wall Street Journal, July 9, 1999. [link]
External links
- [Deinstitutionalization - Encyclopedia of Mental Disorders]
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