Psychiatric deinstitutionalization: the possibilities and the reality

There is a substantial research data base which indicates that the majority of the chronically mentally ill can function outside of institutional settings. A number of community support programs have been implemented and positively evaluated. However, despite this evidence, large-scale deinstitutionalization of these patients has not occurred. Instead, patients have been relocated to new institutional placements such as nursing homes and single-room only hotels (SRO's). The role of Medicaid and Supplemental Security Income (SSI) in mental health care appears to have contributed to limited placement options. In addition, deinstitutionalization has created ambiguity around the degree of dependence and social role status of these patients. Recommendations are made to provide the deinstitutionalized mentally ill with a viable social role using existing financial resources.