Deinstitutionalisation

Overview
Deinstitutionalisation is the practice of moving people (especially those with developmental disability) from mental institutions into community-based or family-based environments.

The idea took hold in various countries in the 1950s and 1960s, possibly as part of the anti-psychiatry movement, which saw incarceration of the mentally ill as often unnecessary and/or inhumane. It was also introduced as a cost saving measure, or a sensible alternative to state hospitals, as long as the discharged patients were serviced in their new community health centers and were able to take their necessary medications. New psychiatric medications were thought to have made it also possible to release this population into the community safely.

In the United States
In the early part of the 20th century, people with mental retardation and other developmental disabilities received services in large public institutions or were cared for by their families with very little financial and social support from the government. In the 1960s, due largely to a series of class action lawsuits and the scrutiny of institutions through disability activism, the appalling conditions and the poor treatment of patients in these institutions were revealed.

This led to a debate about deinstitutionalizing those who are capable of living in the community and developing a more flexible service delivery system to serve them.

A significant catalyst in the United States was the Community Mental Health Act of 1963.

It has been used by some governments and their agencies to save money by closing down, scaling back or merging psychiatric inpatient units. One possible result of this could be that patients who need to, and often want to be admitted to hospital cannot find beds or are discharged before they have fully recovered. Community support services for the mentally ill are a partial solution to this problem, providing care without institutionalisation where possible, although this too can become problematic as it is not necessarily a cheaper option or always an effective one.

In 1999, the Supreme Court of the United States ruled in L.C. & E.W. v. Olmstead that states are required to provide community-based services for people with mental disabilities if treatment professionals determine that it is appropriate and the affected individuals do not object to such placement.

Deinstitutionalisation is thought to have caused widespread homelessness in the United States and some other countries.