What Is Deinstitutionalization in Relation to Homelessness?
America's mentally ill population has been disproportionately impacted by the problem of homelessness. Beginning in the 1960s, state and federal cutbacks for local mental health services forced large numbers of mentally ill people onto the streets and into the revolving door of endless encounters with the criminal justice system. The result is a population that remains vulnerable.
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History
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Broadly defined, deinstitutionalization refers to the transfer of patients from long-term institutions into clinical settings in their home areas, a concept that became known as community care. Several factors combined to create this phenomenon, starting with an increasingly liberalized attitudes about the nature of mental illness. As media reports revealed the extent of institutional abuse and mistreatment, people began questioning whether mental illness existed--and even if it did--whether some kind of alternatives made sense.
Time Frame
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The shape of things to come occurred in 1965, following the specific exclusion of state psychiatric care from Medicaid, the nation's major health program for low-income residents. State governments responded by transferring psychiatric patients into local nursing homes and clinics where reimbursement might be available. Due to funding issues, however--and stiff opposition from the residents being asked to host treatment programs--local programs failed to keep pace. Ill-equipped to live independently, many patients ended up on the streets, often in so-called "psychiatric ghettos."
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Size
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By any objective measurement, the dimensions of the problem are staggering. According to the Treatment Advocacy Center (TAC), more than 90 percent of state psychiatric hospitals closed their doors since 1960, from 559,000 patients with severe brain disorders in 1955, to less than 70,000 at present levels. Closings accelerated during the 1990s--the center's statistics showed that 44 state hospitals shut down between 1990 and 2000, representing more closings than the previous two decades combined.
Effects
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Even in places where community care took hold, the average patient did not have the same degree of attention that prevailed in state facilities, however antiquated or inefficient they may have been. By the 1980s, a struggle to find adequate resources drove many homeless mentally ill people to find care in hospital emergency rooms and clinics unprepared to cope with their numbers. This new found phenomenon created a different "revolving door" for some patients into jails and prisons, which, in the absence of state facilities, became the custodians of last resort..
Warning
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Most experts agree that chronically mentally ill people make up roughly one-third of the nation's one to three million homeless population. To ease their difficulties, advocates lobby for better funding of local programs, elimination of barriers to specialized treatment, and more consistent followup of patient populations. Although the pace of deinstitutionalization has slowed from its 1960s and 1970s peak, lack of adequate federal and state funding has left a patchwork of programs that vary from state to state. How this picture resolves itself amid the concern about the mushrooming federal deficit remains to be seen.
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Resources
- Photo Credit http://kevinturnquist.org/deinst.php
