Question

discuss deinstitutionalization, including what it was meant to accomplish, the problems that haveresulted for people with mental illnesses, and two workable alternatives.

Answer 1

• Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions; it has been a major contributing factor to the mental illness crisis.
• Deinstitutionalization began in 1955 with the widespread introduction of chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication, and received a major impetus 10 years later with the enactment of federal Medicaid and Medicare.
• Deinstitutionalization has two parts: the moving of the severely mentally ill out of the state institutions, and the closing of part or all of those institutions. The former affects people who are already mentally ill.
• The latter affects those who become ill after the policy has gone into effect and for the indefinite future because hospital beds have been permanently eliminated.
• Most of those who were deinstitutionalized from the nation's public psychiatric hospitals were severely mentally ill. Between 50 and 60 percent of them were diagnosed with schizophrenia.
• Another 10 to 15 percent were diagnosed with manic-depressive illness and severe depression. An additional 10 to 15 percent were diagnosed with organic brain diseases -epilepsy, strokes, Alzheimer's disease, and brain damage secondary to trauma.
• The remaining individuals residing in public psychiatric hospitals had conditions such as mental retardation with psychosis, autism and other psychiatric disorders of childhood, and alcoholism and drug addiction with concurrent brain damage.
• The fact that most deinstitutionalized people suffer from various forms of brain dysfunction was not as well understood when the policy of deinstitutionalization got under way.
• Thus deinstitutionalization has helped create the mental illness crisis by discharging people from public psychiatric hospitals without ensuring that they received the medication and rehabilitation services necessary for them to live successfully in the community.
• Deinstitutionalization further exacerbated the situation because, once the public psychiatric beds had been closed, they were not available for people who later became mentally ill, and this situation continues up to the present.
• Consequently, approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment.
• Deinstitutionalization was based on the principle that severe mental illness should be treated in the least restrictive setting.
• For a substantial minority, however, deinstitutionalization has been a psychiatric Titanic. Their lives are virtually devoid of "dignity" or "integrity of body, mind, and spirit." Self-determination often means merely that the person has a choice of soup kitchens.
• The "least restrictive setting" frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.
• Increased funding can provide new and established services to further support deinstitutionalization. Additionally, increased funding can provide more employment opportunities for counselors to work with the SMI population, thus allowing for more manageable numbers of severely mentally ill (SMI) clients on caseloads.
• Thus, through adequate funding existing services can be improved, training specific to working with the SMI population can be provided, and the opportunity for new and more effective programs can be offered.