The de-institutionalization of mental patients began long before Reagan.
The United States has experienced two waves of deinstitutionalisation. Wave 1 began in the 1950s and targeted people with mental illness.[1] The second wave began roughly 15 years after and focused on individuals who had been diagnosed with a developmental disability (e.g. mental retardation).
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During the 1950s many new drugs became available and incorporated into therapy for the mentally ill. These new drugs were effective in reducing severe symptoms, which would allow people with mental illnesses to live in communities ranging from their own homes to half-way houses to nursing homes, etc.[1] Drug therapy was not only quintessential for the depopulation of mental institutions, but it also opened opportunities for employment of the mentally ill.[1]
President Kennedy's Support of Policy Change
In 1955 the Joint Commission on Mental Health and Health was authorised to investigate problems related to the mentally ill. After winning the 1960 election President John F. Kennedy took a special interest in the issue of mental health because his sister Rosemary was mentally disabled.[1] Shortly after his inauguration, Kennedy appointed a special "President's Panel of Mental Retardation".[1] The panel included professional and leaders of the organization. In 1962, the panel published a report with 112 recommendations to better serve the mentally ill. In conjunction with the Joint Commission on Mental Health and Health, The Presidential Panel of Mental Retardation and Kennedy's influence, two important pieces of legislation were passed in 1963: The Maternal and Child Health and Mental Retardation Planning Amendments and the Mental Retardation Facilities and Community Mental Health Centers Act.[1] The first piece of legislation increased funding for research that focused on prevention methods of retardation. The second piece of legislation provided funding for community facilities that serve people with mental disabilities. Both of these Acts furthered the process of deinstitutionalisation.
The shift to community based mental health care
In general, professionals, civil rights leaders, and humanitarians saw the shift from institutional confinement to local care as the appropriate approach.[1] The Deinstitutionalization Movement started off slowly but gained momentum as it adopted the philosophy of the Civil Rights Movement
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Government's desire to reduce cost and spending on hospitalisation
As hospitalisation costs increased due to improvements advocated by civic groups, both the federal and state governments were motivated to find less expensive alternatives to hospitalisation.[1] Moreover, the 1965 amendments to Social Security shifted about 50 percent of the mental health care costs from the states to the federal government.[1] This motivated the government to promote deinstitutionalisation. With the government on the side of deinstitutionalisation, getting legislation passed proved less difficult and problematic.
A number of factors led to an increase in homelessness, including macroeconomic shifts, but observers also saw a change related to deinstitutionalisation.[21][22][23] Studies from the late 1980s indicated that one-third to one-half of homeless people had severe psychiatric disorders, often co-occurring with substance abuse.[24][25]
A process of indirect cost-shifting may have led to a form of "re-institutionalisation" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant.[26][27] Indeed, when laws were enacted requiring communities to take more responsibility for mental health care, funding to facitlitate this could be absent, resulting in jail as the default option,[28] with jails long documented as cheaper than psychiatric care.[26] In Summer 2009, author and columnist Heather Mac Donald stated in City Journal, "jails have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly... at Rikers, 28 percent of the inmates require mental health services, a number that rises each year."[29]
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Remember One Flew Over the Cuckoo's Nest? A film pushing the idea that mental hospitals were torture chambers. |
