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In defense of deinstitutionalization.

G J Clarke

    The Milbank Memorial Fund Quarterly. Health and Society
    |January 1, 1979
    PubMed
    Summary

    Political and economic factors drove deinstitutionalization, supported by various professionals. While Medicaid and SSI aided this shift, they now hinder state hospital reform, despite progress.

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    Area of Science:

    • Health Policy
    • Social Psychiatry
    • Public Health

    Background:

    • Deinstitutionalization policies were widely supported by psychiatrists, social reformers, and civil libertarians.
    • The movement aimed to transition individuals out of long-term psychiatric institutions.

    Purpose of the Study:

    • To examine the political and economic drivers of deinstitutionalization.
    • To assess the impact of federal programs like Medicaid and Supplemental Security Income (SSI) on deinstitutionalization and subsequent hospital reform.

    Main Methods:

    • Analysis of historical political and economic decisions.
    • Review of the role of federal programs (Medicaid, SSI) in mental healthcare.
    • Assessment of progress and challenges in state hospital reform.

    Main Results:

    • Deinstitutionalization was propelled by political will and economic considerations, garnering broad professional support.
    • Medicaid and SSI facilitated the closure of institutions but created complexities for reforming remaining state facilities.
    • Despite challenges, advancements in the care of individuals previously in state hospitals have been made.

    Conclusions:

    • The deinstitutionalization movement, while beneficial in many aspects, presents ongoing challenges for the structure and funding of mental healthcare systems.
    • Federal programs require re-evaluation to better support the reform of remaining state psychiatric hospitals.
    • Continued progress in mental healthcare necessitates addressing the systemic impacts of policy decisions.

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