Deinstitutionalization: The Illusion of Policy

In: Journal of policy history: JPH, Band 9, Heft 1, S. 48-73

Abstract

Examines deinstitutionalization in the 20th century not as a single, consistent public policy, but as a result of unrelated, successively worsening developments in the mental health field. After 1945, inpatient mental hospitals were not as socially & medically endorsed because of such factors as the efficacy of outpatient treatments demonstrated by the experiences of WWII & journalistic exposes that showed the Depression's impact on mental hospitals. The introduction of Medicaid, which transferred the care of the elderly from mental hospitals to nursing homes, & Social Security Disability Insurance, which provided an income to those who were disabled & incapable of holding a job, also had significant effects on deinstitutionalization, since both shifted financial responsibility from state to federal governments & resulted in inpatients being discharged from mental hospitals. The effects of deinstitutionalization on the subgroup of young mentally ill adults with high rates of alcoholism & substance abuse, which led to high rates of homelessness, are also analyzed. Successful examples & suggestions for improving services for the chronically mentally ill are discussed. C. Haywood