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History of the Deinstitutionalization Movement

The term deinstitutionalization refers here to a movement that occurred in abnormal psychology. The paper provides various definitions for deinstitutionalization and runs through the history of the movement. The causes for the deinstitutionalization movement are also tackled. The ethical considerations that need to be made as a result of the effects of the movement are also described. Although the general causes for the deinstitutionalization movement were valid, traditional practice of the said movement’s procedures need to be reevaluated and customized to fit the more current needs of abnormal psychology patients.

History of the Deinstitutionalization Movement Abnormal psychology has witnessed many different changes in the methods applied to take care of the mentally ill. One such drastic change in the face of abnormal psychology was caused by the deinstitutionalization movement. This movement has been the subject of much research and debate. Even to this day, there are those who continue to investigate the merits of the movement and those who persist in pointing out the negative effects brought about on the community and on mentally ill patients by the same.

Deinstitutionalization is defined to be a trend in the care of mentally-ill individuals that involves having less and less of these types of patients become stay-in patients of mental hospitals. The trend of deinstitutionalization also involved the reduction of mental health treatments in public hospitals. (Polgar, 2007) Another definition of deinstitutionalization stated that it was a term used to refer to an implemented policy of moving out of severely mentally ill individuals from state healthcare institutions.

These institutions were then partially or completely closed down after the mentally ill had been moved out. (Torrey, 1997) A less psychology-based definition of the term deinstitutionalization states that it is the act of turning a legitimate established practice of a given organization into an illegitimate one. It is said to have been caused by the organization’s inability to continue in the performance of previously well-established sets of actions. (Oliver, 1992) This paper presents the history of the deinstitutionalization movement.

The antecedents of the trend are brought into light and are analyzed. Also, the effects of the deinstitutionalization movement on mentally ill individuals, on the community, and on society are explored. Ethical considerations of the movement are also presented. All of these features of the deinstitutionalization movement will provide a comprehensive understanding of the progression of the said movement through the years. Antecedents and Progression State hospitals were established in the early 1800’s and became the official institutions tasked with taking care of physically sick individuals.

(Talbott, 2004) It was not until 1890 that state hospitals took responsibility for the mental hospitals housing mentally ill individuals. (Polgar, 2007) Ever since then, state healthcare facilities took the bulwark of the immense task of taking care of the psychologically disturbed and disabled individuals of society. However, this service would soon be put to a premature end. Deinstitutionalization historically began in 1955. During this time, America’s state hospitals reached an ultimate high of 560,000 patients as based on the national census. (Talbott, 2004) 1955 also saw the introduction of chlorpromazine in the psychiatric market.

Chlorpromazine or Thorazine was the first antipsychotic medication to be sold for purposes of treating the mentally ill. (Torrey, 1997) The year 1955 thus signaled not only a crisis in hospital admissions but also a change in available medications for mentally ill individuals. After 1955, a steady decrease in the admitted patients in state hospitals was noted. This signaled the actual onset of the trend of deinstitutionalization. Deinstitutionalization involved a number of different antecedents all of which were essential in provoking the movement’s initiation.

First, a community mental health philosophy was developed which stated that mentally ill individuals would be better off treated near their families and communities. Second, the developments in psychopharmacology provided a way for the symptoms of mentally ill individuals to be decreased. The advent of new medicine allowed for mentally ill patients to be discharged with less threat to society as opposed to their initial conditions (Polgar, 2007). Third, legal actions, which established the specific circumstances under which mentally ill patients could be treated in state hospitals, became more and more important.

Fourth, funds could be freed up with the moving out of the mentally ill. Health insurance companies and government policies enabled state hospitals to transfer the financial load included when taking care of the mentally ill to federal auspices. (Talbott, 2004) These factors answer to the essential pressures that form the antecedents to deinstitutionalization. These pressures are political, functional, and social in nature. (Oliver, 1992) All three pressures were already present in the situation of the state hospitals in 1995 thus creating an environment that was ideal for deinstitutionalization.

The movement of deinstitutionalization included two steps. The first involved discharging patients to their families or communities. The second involved a lessening of patients allowed to be admitted in the state’s healthcare facilities. Various sectors of the government and of the health care industry initially feigned disapproval of the trend. However, it was soon evident that the integration of the policy in all the state hospitals was being conducted. (Talbott, 2004) A majority of the patients that were discharged from the state hospitals were mentally ill individuals.

50 – 60% of these had been diagnosed with schizophrenia. 10 – 15 % had been diagnosed with manic-depressive disorders and other forms of severe depression and another 10 – 12 % had been diagnosed with organic brain diseases which included illnesses such as epilepsy, Alzheimer’s disease, and brain trauma. (Torrey, 1997) With regard to patient admission in state hospitals, a trend was also noted. The mean number of psychiatric in-patients went down from 2000 patients in 1958 to a meager 500 in 1978, only 20 years later.

(Polgar, 2007) These showed that a large number of the population of mentally ill individuals was not receiving proper medical attention and care. The per-capita expenses for mental health were also seen to rise within the period of 1969 to 1994. From an initial $16. 53, it went to $19. 33, which indicated a $2. 80 increase over a 25 year period. (Polgar, 2007) This did not, however, indicate that budget allocations for state and county mental hospitals had also risen. In fact, within the same 25 year period, funds spent on these institutions were recorded to have lowered from $9. 11 to $4.

56, creating a $4. 55 difference within the period. (Polgar, 2007) The trends shown by the deinstitutionalization movement were clear warnings of the great psychiatric crisis that was to come as a result of the movement. Several academicians and citizens expressed their concern and anger with the way the situation was being handled. Complaints on the threats of deinstitutionalization were heard from different sectors of society. Concern was expressed by numerous individuals even including individuals associated with the field of psychiatry and individuals holding government positions. (Reich, 1973)

Despite the protests, the trend of deinstitutionalization continued. In 1971, the plight of the community organizations and general hospitals could no longer be ignored. These institutions together with other concerned agencies had been trying to handle the large patient discharges of the state hospitals. Non-state institutions and agencies put efforts and resources into expansion and program development in order to address the needs of the patients that had been discharged from the state institutions. However, these efforts were not enough to meet the growing demand for healthcare services of mentally ill individuals. (Talbott, 2004)

Today, deinstitutionalization continues to be one of the major problems faced by community service agencies and by other like-oriented institutions. The effects of deinstitutionalization continue to provide large challenges to the capacities of these institutions. The crisis caused by the deinstitutionalization movement on the psychiatric community in particular and to society in general is still being resolved. It is clear, however, that the progression of the movement has not yet stopped. Today, an approximate number of 2. 2 million severely mentally ill individuals failed to receive any form of the mental health services due them.

(Torrey, 1997) Consequences and Ethical Considerations The deinstitutionalization movement had numerous factors contributing to its beginnings. However, the effects and consequences that came as a result of this movement are far more numerous and implicating than those said contributory factors. The ethical considerations that are involved in the movement are equally implicating and thus require an entire section for themselves. The consequences and ethicality of deinstitutionalization can best be understood through an initial assessment of what mentally ill individuals are capable of doing when placed in the community setting.

Families with severely mentally ill members reported 11% of the mentally ill members to have assaulted another person within the period of a year. Also, 27% of the discharged male and female mentally ill patients admitted to having performed at least one violent act within an average of four months after they had been discharged from a mental health facility. Severely mentally individuals who were allowed to live within a given community were also reported to be three times more prone than the average person to use a weapon on another person or even to simply hurt someone severely.

(Torrey & Zdanowicz, 1998) These are clear case of deinstitutionalization gone wrong. Instead of allowing for treatment to be done in a less restrictive area (Polgar, 2007), mentally ill individuals with violent tendencies were instead introduced into a setting where normal individuals, who are incapable of appropriately handling and addressing the needs of the mentally ill, are made to come into daily contact with them. According to French (1989), the deinstitutionalization movement has been a trend that has created more reactive control in society and less pro-active control in the same.

This means that individuals are made to react to the situations created by the movement while those in power do less in less to solve the problem. It should be clear to those effecting the deinstitutionalization movement that as much as teeming institutions offer a poor alternative to possible quality community services, poorly supervised, understaffed community facilities with only a smattering of psychiatric experts on hand can not provide even adequately to the needs of the clinically ill. (French, 1989) Ethically, deinstitutionalization also creates problems.

The discharge of clinically ill patients from hospitals into the community without even an assurance that these mentally ill individuals are able to receive medication and rehabilitation services is highly irresponsible. It is simply the throwing out of individuals who can not complain into an environment where they are not sure to survive. (Torrey, 1997) Ethically, the institutions practicing deinstitutionalization are also held liable for the violent acts commited by the mentally ill patients they discharged.

The list of acts taken from Torrey and Zdanowicz (1998) were only a few examples of the longer list of possible harm a mentally ill patient could inflict upon others and even upon himself or herself. It is clear that deinstitutionalization is unethical even if only in the respect that it fails to account for potential risks that the discharge of mentally ill patients may pose. Severely depressed individuals, for example, could resort to self-injury and even suicide attempts if left to fend for themselves without the chance of receiving medication or medical attention.

Another possible consequence of deinstitutionalization includes the increase in homeless mentally ill individuals. Presently, an approximated of 30-50% of homeless individuals are mentally ill. (Polgar, 2007) This not only poses risks for the said individuals but also to society as well because it presents risks of violent attacks occurring more frequently in neighborhoods where these individuals most often choose to roam. Conclusion The concept of deinstitutionalization was initially made out by its advocates and instigators to be the liberation of mentally ill patients.

It displayed an idealistic notion that when patients were discharged from their state hospitals and psychiatric wards, they would be taken care of by family members or by the community. (Polgar, 2007) It viewed mentally ill individuals as capable of sticking to meditations prescribed for them or to rehabilitative techniques that were assigned to them. However, this was not the case. Not all mentally ill patients were accepted back by their families. Not all mentally ill patients, in fact, had families.

Also, the community that the state hospitals and that the government relied so heavily upon to provide for the needs of the patients could not do so effectively. There was a lack in skill, resources, and manpower. The needs of the mentally ill could not be adequately addressed by community agencies or by general hospitals. The mentally ill individuals also often experienced relapses, as is expected, and this resulted in violent behavior that caused harm not only the patient but also those in his or her direct vicinity as well.

What was initially supposed to be a humane policy providing an alternative to a hospital’s restrictive care (Polgar, 2007) became a slow demise of mental health care. It is clear that reforms are needed in order to rectify the wrongs caused by the initiation of the deinstitutionalization movement.


French, L. (1989). Deinstitutionalization or victimization? A reply to Segal. Social Work, 34(5), 471-472. Oliver, C. (1992). The antecedents of deinstitutionalization. Organization Studies, 13(4), 563-588. Polgar, M. (2007). Deinstitutionalization. Encyclopedia of Mental Disorders. Retrieved on 22 April 2008 from <http://www.minddisorders. com/Br-Del/Deinstitutionalization. html> Reich, R. (1973). Care of the chronically mentally ill: a national disgrace. American Journal of Psychiatry, 130, 911-912. Talbott, J. A. (2004). Deinstitutionalization: avoiding the disasters of the past. Psychiatric Services, 55(10), 1112-1115. Torrey, E. F. (1997). Out of the shadows: confronting America’s mental illness crisis. New York: John Wiley & Sons. Torrey, E. F. , & Zdanowicz, M. (1998). Why deinstitutionalization turned deadly. Wall Street Journal. Retrieved on 22 April 2008 from <http://www. psychlaws. org/generalresources/Article2. htm>

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