Deinstitutionalization in the absence of consensus

Area of Science:

• Public Health
• Health Services Research
• Social Policy

Background:

• Deinstitutionalization of state hospitals began in 1955, marked by declining populations but lacking adequate planning and social consensus.
• This process resulted in criticism, personal hardships, and widespread programmatic disarray.
• Between 1950 and 1970, the total institutionalized population in the U.S. remained unchanged, merely relocated.

Purpose of the Study:

• To analyze the reasons behind the increasing polarization of opinions on deinstitutionalization.
• To examine the impact of deinstitutionalization on various stakeholders, including professionals, officials, families, and advocacy groups.
• To propose a revised approach to deinstitutionalization focusing on comprehensive care for the chronically ill.

Main Methods:

• Historical analysis of deinstitutionalization trends in the U.S. from 1950 to 1970.
• Examination of criticisms and challenges arising from the deinstitutionalization process.
• Review of stakeholder perspectives and their role in the policy debate.

Main Results:

• Deinstitutionalization proceeded without sufficient planning, leading to significant negative consequences.
• A notable shift, rather than a reduction, in the institutionalized population occurred between 1950 and 1970.
• Polarization intensified among diverse groups regarding the efficacy and implementation of deinstitutionalization.

Conclusions:

• Deinstitutionalization's focus should be broadened from the site of care to the overall improvement of life for chronically ill individuals.
• A comprehensive service and financing system is needed to address both daily living and medical requirements of the chronically ill.
• Effective deinstitutionalization requires a shift in perspective towards holistic patient care and support systems.