The Mental Illness Approach Doesn’t Work
It is time to declare psychiatric deinstitutionalization a dismal failure.
Beginning in the 1950s, California began to shift its chronically mentally ill population from major public hospitals to nursing homes, group homes, and other care facilities. Other states soon followed suit, with many large public hospitals closed or drastically reduced in the early 1980s.
It was no doubt a well-intentioned plan to move patients with mental illness from aging and, in many cases, poor-care facilities to a better setting. The idea was to reintegrate people with mental illness into their local communities.
So what was wrong?
In a nutshell, funding – or lack of funding. In 1980, President Carter signed the “Mental Health Systems Act” to promote community mental health clinics. This initiative was never properly funded. Shortly after President Reagan took office in 1981, funds were diverted to state block grants.
This has left thousands of people with chronic mental illness without recourse, resulting in an explosion of homelessness. Hospital emergency departments have become the de facto provider of mental health services. This situation only worsened over the following decades.
The largest mental health service provider in the state of Illinois happens to be the Cook County Jail. There is no national policy for treating the chronically mentally ill. When major public hospitals began to close, the patient population did not miraculously improve. We see evidence of this every day in any major city.
We need to reinvent a better solution to take care of this very fragile and vulnerable population. And that may require government-funded long-term care facilities that are more humane than their predecessors. What currently exists is a shameful patchwork of ineffective and ineffective emergency psychiatric care.
This is a crucial moral question.