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Deinstitutionalization: Leaving Patients Behind
Word count: 1306. In-text APA citations preserved. References available in the full PDF from Mrs. Cohen.
Introduction
News of the deinstitutionalization movement has passed by, unnoticed since its commencement in the 1960's. However, growing concerns over poverty, prison overcrowding, and civil rights of mentally disabled patients call for recognition and deep understanding of deinstitutionalization as a major contributor to these problems. According to Lamb, a professor at University of Southern California School of Medicine, Los Angeles and Bachrach, veteran author of 41 articles on the topic of deinstitutionalization, deinstitutionalization is defined as the replacement of state or federal run psychiatric hospitals with community-based alternatives (Lamb & Bachrach, 2001). The government implemented this policy of deinstitutionalization because of "the belief that mental hospitals were cruel and inhumane, hope that new medications [opposed to the ineffective treatment from the institutions] offered a cure, and the desire to save money" (Yohanna, 2013). Overall, the government expected deinstitutionalization to improve the lives of the mentally ill. Since the commencement, the program strived to develop independence among patients by increasing employment and interaction with others. Unfortunately, these positive outcomes occur only where mental community services are well-established and maintained (Kliewer, McNally, & Trippany, n.d.). In actuality, a majority of the released patients experience unintentional, negative consequences of deinstitutionalization such as homelessness, incarceration, and isolation due to the absence of the promised community care.
Patient Homelessness
The absence and lack in quality of community-based mental programs contributes to the failure of the deinstitutionalization movement to improve the lives of mental patients. The major obstacle facing the success of deinstitutionalization is limited funding for mental centers which results in an unprofessional staff and ineffective services (Kliewer, McNally, & Trippany, n.d.). Flory and Friedrich, co-directors of the National Alliance for the Mentally Ill Long-term Care Network, provide examples of the effects caused by limited funding through the complaints of families who have directly experienced the unsuccessful community centers. Many described the lack of 24-hour supervision when needed. They also delineate their experience with the revolving door syndrome, the frequent transportation of patients caused by the lack of adequate housing. One woman explains how her schizophrenic son had been moved in the system 62 times; thus, her son remained ill for 20 years due to lack of treatment (Flory & Friedrich 1999). Revolving door syndrome causes patient instability and leads to forced homelessness because of the brief treatment duration and forced discharge from government institutions. Madianos, president of the World Association for Psychosocial Rehabilitation and professor of general and social psychiatry at the University of Athens, delineates the direct correlation between the economic level of a country and availability of mental health programs; only 51.7% of the impoverished countries had available services while 97.4% of the wealthy countries had available services (Madianos, 2010). Thus, his study supports the concept that community services assist countries in escaping poverty by housing and treating the mental patients who make up "a third to a half of all homeless adults" (Lamb & Bachrach, 2001). The failure of the deinstitutionalization movement caused by insufficient funding of community mental centers results in increased patient homelessness after they experience the revolving door and realize they have no place to stay.
Increased Crime Rate and Prison Overflow
Patient homelessness caused by deinstitutionalization leads to increased crime rates among the mental patients. Often they resort to crime in order to purposefully go to jail where they can be fed and housed. In fact, in a survey conducted by Smith (2012), an editor of the Sociology Compass journal, it was found that "around 40 percent of severely mentally ill people have been arrested at least once in their lives." Additionally, patients' untreated mental illnesses can also influence them to commit severe crimes. For example, up to 50 percent of mass homicides have been associated with people suffering from serious mental illnesses (Treatment Advocacy Center). Providing more evidence of increased crime, Wallace, Mullen, and Burgess (2004) conducted a study where they examined the frequency of offenses among schizophrenic patients over a 25-year period during the deinstitutionalization experience. They discovered that the patients' rate of offending rose from 7.4 percent in 1975 to 11.9 percent in 1995. Therefore, deinstitutionalization set an impetus for the increase crime rate of mental patients. As a result of the increased crime rate, deinstitutionalization also contributes to the overcrowding of prisons. For example, "[m]ore than 1.8 million people with SMI [severe mental illnesses] are booked into jails every year" (Treatment Advocacy Center, n.d.). Flory and Friedrich (1999) add that there happen to be more mental patients in jail than patients receiving proper treatment. In the prevention of prison overflow and crime, deinstitutionalization should be stopped or carried out a different way.
Isolation and Suicide
Patients who avoid homelessness or imprisonment often experience isolation from society which could eventually lead to suicide. Successful recovery and functioning of mental patients depend on the material assistance and emotional support provided by the community as stated by Bachrach (1976) in her book Deinstitutionalization: An analytical review and sociological perspective published by the National Institute of National Health. However, when mental patients are forced into community settings, they often experience isolation from others. Bachrach (1976) explains how there seems to be a "consensus that society has difficulty in dealing with the presence of mental patients in their midst." Although the book was published in the 1970's, Bachrach provides an accurate reaction of the community to the mental patients since the repercussions of the deinstitutionalization movement became prominent around this time period. Additionally, Kliewer, McNally, and Trippany support Bachrach's claim by suggesting that "the community at large is frequently afraid of people with mental illness, believing them to be dangerous. This belief often cause[s] rejection" of the patients through victimization and harassment (Kliewer, McNally, & Trippany, n.d.). Bachrach continues to give examples of the methods many use to isolate the patients such as city ordinances, zoning codes, and unnecessary police arrests (Bachrach, 1976). In a majority of the cases, isolation serves as an impetus for suicide. In fact, "[u]p to 50% of those with schizophrenia or bipolar disorder attempt suicide" (Treatment Advocacy Center, n.d.) and one in ten are successful in completing suicide (Flory & Friedrich, 1999). Suffering from societal rejection and abandonment, mental patients resort to suicide to "solve" their afflictions. As a solution, Richan and Eidelman (1975) propose that "[w]e must not, however, spend a lot of time in talking, writing, and holding conferences and seminars on deinstitutionalization.... We must concentrate our efforts in [the] direction" of becoming more active in improving and participating in community mental services. Richan and Eidelman, journalists for the National Association of Social Workers, call for action to improve the community services in order to prevent the suffering of mental patients because this journal emphasizes the importance of social work in all different types of dire situations.
Conclusion
Despite the positive intentions of the deinstitutionalization programs, the commencement has been followed by a majority of unintentional negative consequences. To prevent ostracization of patients, wider understanding of mental illnesses should be implemented through educational programs for a higher chance of the social acceptance of the mentally disabled patients. As a solution to the increased crime rates of mentally ill people and prison overpopulation, Smith (2012) offers the plan of diverting some of the funds used by the criminal justice system to handle the mentally ill people to the community mental services. With a majority of the crime and inmate sources diverted towards community centers for treatment, the criminal justice system would not need the full funds to manage its tasks. However, this plan must be executed gradually as immediate transportation of the money would result in the collapse of the criminal justice system. Thus, the responsibility is now in the hands of those who are aware of this crisis to find a solution for these patients to live with the greatest degree of life, liberty, and their pursuit of happiness.