Deinstitutionalization

History

As early as the 1860s, Dorothea Dix began to write about overcrowded and inhumane conditions in psychiatric hospitals. In 1908, Clifford Beers, after being released from a state institution, published A Mind That Found Itself, an exposé of conditions inside state and private mental institutions. In the United States, interest in programs to improve mental health grew during World War II when some draftees were found unfit for service due to mental illness.

In 1946, the National Mental Health Foundation was founded by conscientious objectors who had served as attendants at state mental institutions during World War II. they worked to expose the abusive conditions at these facilities, and this became an early impetus in the push for deinstitutionalization. At the same time, the U.S. government began to fund research into treatment and prevention of mental illness with various initiatives; one was the formation of the National Institute of Mental Health (NIMH). The NIMH refers to deinstitutionalization as a process put in place to prevent inappropriate admission and confinement of the mentally ill in institutions and to provide community support systems for mental health services.

During a congressional address in the early 1960s, President John F. Kennedy discussed the need for reforms in mental health. Around that time, the Joint Commission on Mental Illness and Health, a federal agency, released a report titled Action for Mental Health. This report cited the extreme costs of institutional care, the lack of therapeutic effectiveness of long-term care, and the deplorable conditions in Many large public institutions. Simultaneously, reformers and mental health advocates determined that the care in these institutions was often worse than the effects of mental illness. they began to lobby for the release of these patients into community settings, or deinstitutionalization.

The federal government provided funding to support the release of patients with the passage of the Community Mental Health Centers Act of 1963 and its amendment in 1965. This act appropriated federal funds for the construction of community mental health centers with a goal of diminishing the state mental hospital's role as a major resource for the mentally ill. The plan was to establish a program of federal, state, and local services in the community. The services were to provide prevention, early detection, treatment, and rehabilitation for the mentally ill with case management, counseling, and a clinic to distribute antipsychotic medications.

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