The paradox of psychiatric deinstitutionalization: historical perspective and policy implications

Deinstitutionalization has, in effect, resulted in the creation of new forms of asylum for the mentally ill. Rather than being generated in a planful, humanitarian manner, the reduction in the census of state hospitals has been governed by federal health and welfare programs not designed for the mentally ill. By relying upon Medicaid and SSI, states were able to shift their financial burden for the mentally ill to the federal government. Reliance upon Medicaid has resulted in nursing homes playing a major role in psychiatric care. SSI stipends are not adequate to cover rising housing costs--even in low-income areas. As a result, large numbers of the mentally ill are among the populations of homeless persons in the United States.