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Understanding Deinstitutionalization

Understanding Deinstitutionalization

You have likely heard or read stories about the conditions of mental health institutions in the past. Society has come a long way in the treatment of mental health. The governmentally mandated process of deinstitutionalization played a significant role in changing the stigma surrounding psychiatric conditions.

Deinstitutionalization is the link between the past and future of mental healthcare. Here we discuss mental health institutionalization and deinstitutionalization causes, effects, and its pros and cons.

Psychiatric Institutionalization

Initiatives to provide care to mentally ill patients have consistently existed in some form for at least the last 1200 years. For most of this time, psychiatric facilities were run by religious institutions. By and large, mental illness was dismissed as personal or religious “problems.”

Modern Origins

Institutionalism began in Britain after the 1808 County Asylums Act was passed. Psychiatric care became a state initiative rather than a religious or community initiative. Institutionalism ushered in a new privatized standard for the psychiatric hospitals as well the standard for the general conditions in those facilities.

Occupants of psychiatric hospitals after 1808 were subjected to prison-like environments affixed with barred rooms and unsanitary living conditions. Patients were also subjected to physical restraints such as handcuffs and straitjackets.

British public policy efforts were made in 1845 Britain to establish rights for patients housed in these facilities. The Lunacy Act 1845 outlined a set of requisite standards for asylums that included inspections, qualified staff physicians, and an established regulatory operation protocol.  

Widespread Institutionalization

During the mid to late 1800s, large privately held psychiatric institutions sprang up in Europe, and the colonized countries of Australia, South Africa, and the United States. With the rise of these institutions also came an increase in occupancy in mental health facilities.

With growing occupancy, psychiatric hospitals were understaffed and under-funded.

In the US, activism by Dorothea Dix led the government to establish over 30 state-run psychiatric facilities. Dix’s motivation was to improve living conditions for patients.

Long-term in-patient psychiatric was considered the best way to treat mental illness. Institutionalism was often embraced because it removed mentally ill, homeless, deviant, or outcasted citizens from the community.

Institutionalized patients were routinely subjected to treatments such as electroconvulsive therapy, (electroshock therapy, ECT) and lobotomy.

Paradigm Shifts

Before the 19th Century era of institutionalization, psychiatric facilities were reserved for patients with severe mental health conditions. Severe mental health conditions were considered those that prevented self-sufficiency and mobility, as readily and casually observed in severely mentally or physically handicapped patients.

During institutionalization, however, the definition of this deemed “insanity” shifted to include a much larger spectrum of the population. Whereas the definition of “insanity” was once a matter of discerning a patient’s physical and mental capacity to function in the world, “insanity” transformed into a subjective label that any physician could diagnose based on personal opinion and/or motivations which became a source of public distress during this time.

By 1955, over half a million patients were admitted to state hospitals in the United States. This marked the height of the occupancy for mental health facilities. Patients had a wide variety of conditions including:

  • Autism
  • Bipolar disorder
  • Dementia
  • Drug addiction induced brain damage
  • Major depression
  • Psychosis
  • Schizophrenia
  • Trauma induced brain damage

Cause And Effect

The Rise of Deinstitutionalization

By the mid-1950s support for institutionalism was waning, and the fall of institutionalization gave rise to deinstitutionalization.

As the early 1960s came around, the US government established community health centers to treat less severe mental illnesses. The goals for the community centers was to help mental health patients better integrate into society. The Community Mental Health Centers Construction Act aimed to create these community mental healthcare centers.

From this time forward, legislation pressed to eradicate federal funding large psychiatric institutions.

Deinstitutionalization was the official government-sanctioned process of removing patients en masse from the large, privately owned inpatient psychiatric facilities. Patients were transferred back into the care of a state or community operated and federally funded mental healthcare system.

Causes

There were three driving forces behind deinstitutionalization that included scientific, social, and economic considerations. Causes of deinstitutionalization were:

Advancements In Psychotropic Drugs

By the mid-1950s support for institutionalism was waning, and the fall of institutionalization gave rise to deinstitutionalization.

As the early 1960s came around, the US government established community health centers to treat less severe mental illnesses. The goals for the community centers was to help mental health patients better integrate into society. The Community Mental Health Centers Construction Act aimed to create these community mental healthcare centers.

From this time forward, legislation pressed to eradicate federal funding large psychiatric institutions.

Deinstitutionalization was the official government-sanctioned process of removing patients en masse from the large, privately owned inpatient psychiatric facilities. Patients were transferred back into the care of a state or community operated and federally funded mental healthcare system.

Causes

There were three driving forces behind deinstitutionalization that included scientific, social, and economic considerations. Causes of deinstitutionalization were:

Advancements In Psychotropic Drugs

Lithium

Antipsychotic Drugs

Antidepressants

Benzodiazepines

Civil and Ethical Shifts

Federal Funding

Effects

Homelessness

Incarceration 

Violence

Pros & Cons

Here are the pros and cons for deinstitutionalization.

PROS

  • Insufficient funding for mental health treatment in public psychiatric facilities led to atrocious conditions for patients
  • Deinstitutionalization helped establish laws and rights for mental health patients
  • Communities can no longer institutionalize others based on subjective reasoning and opinion
  • The stigma around mental health is fading, placing mental health concerns into the public sphere

CONS

  • Patients with severe mental illness often benefit from long-term inpatient treatment in a facility
  • Mentally ill patients who do not receive treatment may present social problems because of the negative impact of homelessness and/or incarceration
  • Current laws make involuntary entry into a mental health facility very difficult even when the safety of the patient or the safety of others is at stake

Conclusion

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Deinstitutionalization helped establish human rights for mental health patients, but it has not served every patient in the mental health community. Many of the severely mentally ill patients are left without adequate treatment options.

Investigating the history of institutionalization along with the last 50 years of deinstitutionalization can bridge the mental health treatment gap. Lessons from the past can help us find policies that support everyone suffering from mental health concerns. 

​Featured image via Flickr

 

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