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Deciphering deinstitutionalization: complexities in policy and program analysis.

S M Rose

    The Milbank Memorial Fund Quarterly. Health and Society
    |January 1, 1979
    PubMed
    Summary
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    Deinstitutionalization aimed to reform psychiatric care with community centers, but policy and system conflicts left intended beneficiaries underserved. This approach failed to deliver on its promise of improved mental health services.

    Area of Science:

    • Public Policy Analysis
    • Mental Health Services Research
    • Social Psychiatry

    Background:

    • Deinstitutionalization represented a significant policy shift from traditional psychiatric hospitalization.
    • The policy aimed to replace custodial warehousing with community-based mental health care.
    • It was promoted as a progressive, humanitarian, and fiscally conservative reform.

    Purpose of the Study:

    • To evaluate the implementation and outcomes of the deinstitutionalization policy.
    • To analyze the gap between the policy's rhetoric and its practical application.
    • To identify factors contributing to the policy's shortcomings.

    Main Methods:

    • Policy analysis of deinstitutionalization initiatives.
    • Examination of federal and state interests and system coordination.

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  • Review of the impact on intended beneficiaries of mental health reforms.

    • Main Results:

    • The policy rhetoric did not translate into cohesive action across competing interests.
    • Lack of coordination between federal and state systems hindered effective implementation.
    • The intended beneficiaries of the reforms faced unintended negative consequences.

    Conclusions:

    • The deinstitutionalization policy, despite its progressive aims, failed to achieve its objectives due to systemic failures.
    • Competing interests and lack of coordination undermined the creation of effective community mental health services.
    • The policy's implementation resulted in negative outcomes for the population it was designed to serve.