Psychiatry and Deinstitutionalization Essay Example

and care for people with chronic illnesses, including mental health conditions. Local authorities were responsible for providing mental health care during this time period. From 1890 onwards, individual states took on primary roles in managing mental hospitals where patients received custodial care but not active treatment for a cure. The establishment of the National Institutes of Mental Health in the early 20th century brought about new psychiatric medications that were introduced into state mental hospitals starting in 1955. These medical advancements provided hope for those affected by mental illness.President John F. Kennedy's Community Mental Health Centers Act in 1963 accelerated deinstitutionalization by creating community wellness centers as alternatives to traditional institutions. In the 1960s, Medicare and Medicaid were introduced, leading to the federal government assuming some responsibility for mental health care costs. The Supplemental Security Income program was created in the 1970s, with state governments also promoting deinstitutionalization for older individuals. Deinstitutionalization efforts varied by state and often negatively affected low-income individuals with mental illness due to a decline in effective mental health care delivery during their transition from public welfare to community care. To address rising hospitalization costs, both federal and state governments sought cheaper alternatives. The Social Security amendments in 1965 shifted around half of mental health care costs from states to the federal government, thereby encouraging deinstitutionalization. Managed care systems emerged in the 1980s and reassessed inpatient hospitalization for those with mental health issues. Public opinion, concern, and private insurance policies aimed to reduce hospital stays and expedite patient release through financial incentives.Deinstitutionalization is the act of removing mentally ill individuals from mental health facilities. However, transitioning to life outside of an

institution can be challenging for these individuals as they may still exhibit behaviors and attitudes associated with institutional living. Despite this difficulty, deinstitutionalization offers those with mental illnesses the opportunity to regain their freedom and promotes their recovery through social workers and psychiatric therapy. This approach is particularly beneficial for individuals in group homes or who have become homeless due to deinstitutionalization.

The increase in homelessness rates has various causes, including macroeconomic shifts. Additionally, research suggests a connection between homelessness and the process of deinstitutionalization. Studies conducted in the late 1980s found that a significant number of homeless individuals had severe psychiatric disorders coupled with substance abuse problems. This presented an immediate challenge for the mental health field at that time since these homeless individuals were previously institutionalized and served as reminders of the negative consequences of deinstitutionalization.

Many mentally ill homeless people who have never received treatment often express frustration about unfulfilled promises of community-based care following deinstitutionalization.Despite being societal issues, homelessness and mental illness differ significantly from each other. The lack of preparation and support after discharge often leads to mentally ill individuals becoming homeless or ending up in prison. Several states in the USA have experienced widespread homelessness, with approximately one million chronically mentally ill homeless individuals currently residing in major cities across the country. While deinstitutionalization has provided valuable insights, many mentally ill homeless individuals feel disconnected from society and the mental health system. They have fears and mistrust towards others and are unwilling to give up their perceived sense of independence by living on the streets without any accountability. Some may be too severely mentally ill to respond to assistance efforts, while

others may not want to identify as mentally ill or be unable or unwilling to abandon their isolated lifestyle and independence, leading them to refuse acknowledging their dependence on others. Efforts for integration include community services that offer lodging with full or partial supervision within the community; however, these services are reported to be just as expensive as inpatient hospitalization.While deinstitutionalization has shown positive outcomes for most patients, it has also proven ineffective in various aspects. The initial expectation of social integration through community care has not been met, leading to the continued unemployment, social isolation, and sheltered living situations of many discharged individuals. Additionally, the new community services often fail to address the diverse needs of the mentally ill population, resulting in their isolation within a new "ghetto." Families can play a significant role in caring for those who would typically be placed in long-term treatment centers; however, due to the severity of their conditions, many mentally ill individuals lack such support. The majority of those requiring continuous care suffer from paranoia and delusions and refuse help or deny the need for treatment, posing challenges in providing appropriate care. Other studies highlight how economic hardships like unemployment and adversity within the community can adversely affect mental health by contributing to social disruption, criminal activities, and violence. Consequently, sending mentally ill individuals into communities raises concerns and fears among both them and other community members about potential violence.Despite the ongoing trend of closing institutions, deinstitutionalization remains a controversial topic. Many studies have examined the pros and cons, risks and benefits, of institutional versus community living. These studies suggest that adaptive behavior tends to improve when

individuals transition from an institution to a community setting. However, parents who opposed deinstitutionalization were generally dissatisfied with the outcomes when their loved ones moved to the community (Larson & Lakin, 1989; Larson & Lakin, 1991). On the other hand, a recent survey found that deinstitutionalization led to significant improvements in various areas of behavior such as self-care, communication, academics, social skills, community living, and physical development (Lynch et al., 1997). It is evident that individuals with severe mental illness who have been deinstitutionalized face numerous health and social challenges worldwide while struggling to access healthcare services. A survey conducted in a neighborhood with high rates of substance abuse and crime revealed that they were no more likely than current residents to commit violent offenses. Moreover, it should be noted that aggression and violence often occur within family settings rather than between strangers.In the United States, individuals with severe mental illness often face underfunded mental health systems due to their socioeconomic status and financial stability. The healthcare system encounters various challenges in properly caring for those with mental illness, including lack of reimbursement for health education and family support, inadequate case management services, poor coordination and communication between services, and absence of treatment for co-occurring psychiatric and substance abuse disorders. Furthermore, deinstitutionalization is frequently associated with negative attitudes, biases, stereotypes, stigma, and favoritism towards individuals with serious mental illness within the community (Matschinger and Angermeyer 2004). However, altering beliefs and implementing effective community mental health care efforts on a daily basis can change these stigmas and negative attitudes. Deinstitutionalization has been attempted not only in the USA but also in countries such as Italy, Greece,

Spain, and other Eastern countries. Successful deinstitutionalization necessitates prioritizing psychiatric reform alongside implementing an effective system of community-based services supported by sufficient financial resources.This process involves addressing various aspects of an individual's life needs such as ongoing treatment, healthcare including mental health care, housing arrangements, employment opportunities, education prospects, and establishing a functional community support system. The text examines the significance of family involvement in alleviating the state's burden of care. It emphasizes the ultimate objective of integrating individuals independently into their community. Various sources discuss deinstitutionalization and mental health policy (Bachrach 1976; Dowdall 1999; Grob 1994; Hollingshead and Redlich 1958; Redick et al. 1996; Scheid and Horwitz 1999; Schlesinger and Gray 1999; Scull 1989). Chapter 13 of the book "Mental Health.United States.1998," edited by Ronald Mandersheid and Marilyn Henderson contains the text titled "Highlights of Organized Mental Health Services in 1994 and Major National and State Trends." This publication was released by US-GPO in Washington DC with publication number (SMA) 99-3285 in 1998.