Deinstitutionalisation

Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. Deinstitutionalisation works in two ways: the first focuses on reducing the population size of mental institutions by releasing patients, shortening stays, and reducing both admissions and readmission rates; the second focuses on reforming mental hospitals' institutional processes so as to reduce or eliminate reinforcement of dependency, hopelessness, learned helplessness, and other maladaptive behaviours.According to psychiatrist Leon Eisenberg, deinstitutionalisation has been an overall benefit for most psychiatric patients, though many have been left homeless and without care. The deinstitutionalisation movement was initiated by three factors:A socio-political movement for community mental health services and open hospitals;The advent of psychotropic drugs able to manage psychotic episodes; Financial imperatives (in the US specifically, to shift costs from state to federal budgets)According to American psychiatrist Loren Mosher, most deinstitutionalization in the USA took place after 1972, as a result of the availability of SSI and Social Security Disability, long after the antipsychotic drugs were used universally in state hospitals. This period marked the growth in community support funds and community development, including early group homes, the first community mental health apartment programs, drop-in and transitional employment, and sheltered workshops in the community which predated community forms of supportive housing and supported living. According to psychiatrist and author Thomas Szasz, deinstitutionalisation is the policy and practice of transferring homeless, involuntarily hospitalised mental patients from state mental hospitals into many different kinds of de facto psychiatric institutions funded largely by the federal government. These federally subsidised institutions began in the United States and were quickly adopted by most Western governments. The plan was set in motion by the Community Mental Health Act as a part of John F. Kennedy's legislation and passed by the U.S. Congress in 1963, mandating the appointment of a commission to make recommendations for ""combating mental illness in the United States"".In many cases the deinstitutionalisation of the mentally ill in the Western world from the 1960s onward has translated into policies of ""community release"". Individuals who previously would have been in mental institutions are no longer continuously supervised by health care workers. Some experts, such as E. Fuller Torrey, have considered deinstitutionalisation to be a failure, while some consider many aspects of institutionalization to have been worse.