"Community Care": Historical Perspective on Deinstitutionalization

This article examines the discrepancies between the rhetoric surrounding deinstitutionalization and community care and the reality of the abandonment of the seriously mentally ill to their fate. It discusses how the earlier commitment to the asylum came to be abandoned, analyzes various attempts to explain why the mentally ill were decanted from institutions into a largely unreceptive community, and dissects the shortcomings of these actions. The realities of care in the community and the connections of deinstitutionalization to the collapse of public psychiatry, the epidemic of homelessness, and the place of jails as our primary in-patient response to serious mental illness are explored, as is the curious political coalition that endorsed the end of the asylum. The connections of deinstitutionalization to the rise of neoliberal ideas are documented, and the impact of the changed public policy on the life expectancy of those with serious mental illness is analyzed.