Deinstitutionalization at the beginning of the new millennium

Deinstitutionalization, which began in the mid-1950s, has had dramatic effects. It has decreased the number of occupied state hospital beds from 339 to 29 per 100,000 population. The plight of the new generation of chronically and severely mentally ill persons has posed the most serious problem: these individuals no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. A comprehensive, integrated, and adequately funded system of care for this population needs to be established in the community. Where such systems exist, they can lead to higher levels of functioning and a better quality of life. Unfortunately, treatment, housing, and rehabilitation resources are presently insufficient to serve the substantial population of mentally ill in the community. Moreover, some patients who have been deinstitutionalized cannot be effectively treated without highly structured 24-hour care. The way deinstitutionalization has been implemented has probably contributed to the large numbers of severely mentally ill persons on the streets and in jails. Although deinstitutionalization can result in a much richer life experience in the community, much more needs to be done to make that occur.