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Deinstitutionalization Movement of the 1960s and Other Mental Health Issues

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  • 0:06 Mental Institutions
  • 1:24 Deinstitutionalization
  • 2:19 Least Restrictive Setting
  • 3:29 Fallout
  • 4:47 Lesson Summary
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Lesson Transcript
Instructor: Natalie Boyd

Natalie is a teacher and holds an MA in English Education and is in progress on her PhD in psychology.

In the 1960s, a social movement resulted in the widespread deinstitutionalization of mentally ill patients across America. In this lesson, we'll examine the causes and effects of deinstitutionalization, as well as the rights of mentally ill patients.

Mental Institutions

Most people have heard of mental institutions, once called insane asylums. These are hospitals for the severely mentally ill, where they can receive round-the-clock treatment and observation, and where they are kept away from the general population.

For centuries, starting in the Middle Ages, institutions for the mentally ill were the most common form of treatment for mental illness. However, they were not great places to be a patient. Issues ranging from sanitation to outright abuse by staff members haunted mental institutions.

Starting in the 1700s, a series of reforms tried to make institutions safer, better places for the mentally ill. But even as late as the end of the 19th century, asylums were so bad that Nellie Bly, a famous journalist, went undercover in one and noted that in a matter of a couple of months, a sane person would be made insane by the treatment in the institution.

Despite the sometimes appalling conditions of mental institutions, reform was the best thing that could be done. After all, most of the people in the institutions were not able to function in society; they needed a place to live that would be able to accommodate their needs and illness.

Deinstitutionalization

In 1955, though, all that changed with the introduction of Thorazine, the first antipsychotic medication that was effective enough to make it possible for people to be medicated for severe mental illnesses like schizophrenia.

Starting shortly after Thorazine was introduced, the United States went through a major social movement known as deinstitutionalization, where large numbers of mentally ill patients were released from mental institutions to live in the general population. Ten years after Thorazine began the deinstitutionalization movement, federal Medicaid and Medicare were introduced. Because Medicaid and Medicare did not cover patients' costs for living in state mental institutions, many more patients were moved into general hospitals, outpatient medical clinics or halfway houses. In short, they joined the general population.

Least Restrictive Setting

Part of the idea behind deinstitutionalization was the concept of patient rights. As previous reforms had shown, state mental institutions were not always the best places. Not only that, but hope began to form that people could live happy, healthy lives with a combination of medication and therapy.

Patients' rights became a major part of the deinstitutionalization movement, and foremost among patients' rights advocates was the idea of the least restrictive setting. Patients have a right to be treated while maintaining as much freedom as possible. As a result, if a patient could live in the general population with support from medication and therapy, then that is the least restrictive setting.

Of course, if medication and therapy does not work, a patient might need to be put into a halfway house or even an institution. But generally, mental institutions are a last resort, because they are a restricted setting, even if they are the least restrictive setting for some people. Due to deinstitutionalization, the number of people committed to state mental institutions decreased by 92% between 1955 and 1994.

Fallout

You might be thinking that deinstitutionalization and the right of the least restrictive setting are good things, and for the most part, you'd be right. But the deinstitutionalization movement of the 1960s led to some unintended consequences.

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