Deinstitutionalization: Definition & History

Instructor: Maria Airth

Maria has a Doctorate of Education and over 20 years of experience teaching psychology and math related courses at the university level.

The history of deinstitutionalization in the United States is intriguing. This lesson reviews the history of deinstitutionalization and the benefits and consequences associated.

Can you imagine a time when a child with learning disabilities or severe developmental disorders was put into a large dorm-like structure and left to grow up and live out their entire life behind the walls of an institution? It is hard to imagine that this used to be an everyday occurrence. Institutionalization of the mentally ill was seen as a support for society because it removed the burden of the mentally ill person from the parents and the greater community.

Deinstitutionalization

Deinstitutionalization refers to the ideology that locking up mentally ill people is not the best practice for the mentally ill or, in fact, society at large. Deinstitutionalization is the act of removing mentally ill patients from traditional institutions of care and caring for them in more humane and community-based ways. In history, this is seen in a shortening of the length of stay of mentally ill patients in institutions, funding for the support of mentally ill and developmentally disabled people in the community and the building of community-based facilities to continue to offer support for these marginalized people. However, there have been some negative outcomes from deinstitutionalization.

Why Deinstitutionalize?

There was a time when a person with a mental disorder was immediately institutionalized. This means the person was essentially locked away in an institution for the mentally ill. These were not hospitals as we know them but places to put the burdens of society out of sight and mind from the community. In 1773, the U.S. began institutionalizing for the sole purpose of containing the mentally ill. The first institution for the mentally ill was named Public Hospital for Persons of Insane and Disordered Minds.

Treatments common in these institutions were shock therapy and prefrontal lobotomies (a surgery in which the entire front portion of the frontal lobe of the brain is removed). These treatments caused much more harm than good. Additionally, conditions were not good in institutions, as patients were not well cared for. It was 1841 when Dorothea Dix began her public campaign to secure better conditions for people living in these institutions. She felt that a true focus on treatment in an effort to find cures was more productive than the institutions as they existed in her time.

So, the conditions in mental institutions and the public outcry of the few who tried was an impetus to deinstitutionalize. Public outcry and the change in the opinions of the general public was influenced not only by Ms. Dix, but also by the media and artists who brought the issues of institutionalized people to the forefront of public knowledge. One example of art influencing public opinion on mental health is Ken Kesey's One Flew Over the Cuckoo's Nest. Other factors that led to deinstitutionalization included the expense of these institutions (economic factors influenced some of the push to deinstitutionalize), medical advancement (new psychiatric drugs were being found to help maintain patients in more normal lives), presidential support for a reduction in institutionalized patients (like President Kennedy) and the medical communities shift to community based treatment and living.

History of Deinstitutionalization

Even though Dix began fighting for the mentally ill in the late 1800s, it wasn't until the 1950s that a true push to deinstitutionalize began. In 1963 President Kennedy signed the Community Mental Health Act that intended to provide federal funding for community-based living and treatment centers for the mentally ill. Unfortunately the act was not funded adequately, thus was not as successful as had been hoped. However, it was the first official support for the deinstitutionalization of mentally and developmentally disadvantaged people. During this time, there was a huge reduction in the length of stay patients had in institutions and community-based care facilities grew in number across the country. There was also a slow social shift in the way people viewed persons with mental illness and disabilities.

In 1965, Medicaid was the catalyst to deinstitutionalize many mentally ill patients. Unfortunately the country was ill equipped in having alternatives for providing proper care for these people. The unfortunate effect was a drastic increase of mentally ill people in the criminal justice system.

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