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