What is Deinstitutionalization?

Deinstitutionalization is the breaking away from the traditional health care model of public institutions to house people with mental illnesses. Deinstitutionalizing a society's mental health care systems means providing community outpatient services rather than around the clock care inside a public hospital. Rather than isolate patients from the community by confining them in large institutional buildings, the model of deinstitutionalization is supposed to have communities providing each patient with mental health care services.

The health care trend of deinstitutionalization began with the increased number of hospital closures and reduced amount of space available in many public hospitals. The success of psychiatric medicines also led to the deinstitutionalizing of mental health care systems in many parts of the world. Starting in 1890, care for those with mental illnesses became custodial rather than progressive since there often was no cure for the condition. But, beginning in 1955 with the introduction of psychiatric medicines that controlled symptoms such as hallucinations and mood swings, it was discovered that many patients could function without constant care.

In 1963 in the United States, President John F. Kennedy established a Community Mental Health Centers Act. Psychiatric medications were dispensed with careful monitoring and combined with outpatient therapy. A new community-based mental health care model was adopted. It was paid for by the federal government through medical insurance programs such as Medicaid and Medicare. Deinstitutionalization became commonplace for the elderly as well as the mentally ill.

Today, outpatient care continues to increase, while in-hospital mental health models have greatly decreased. People in favor of deinstutionalizing mental health care argue that it not only frees up much needed beds in hospitals, but treats patients in their own community while fostering their independence. Proponents of deinstitutionalized health care systems also point out that the traditional psychiatric hospital, or asylum, model confined patients and isolated them from the rest of society. Those opposed to deinstitutionalization assert that people with serious or complex mental disorders tend to isolate themselves in community settings and many need the regular meals, activities and schedules that traditional hospital care provides. In fact, many deinstitutionalized mental health patients become homeless.

Even those involved in the deinstitutionalized movement have pressed for supported housing for mentally ill people so that living accommodations and at least some supervision to help ensure they would take their psychiatric medications would be provided. Unfortunately, the costs for such care are often the same or even higher than hospitalization in many cases. Cost savings are a big factor in the continuation of deinstitutionalization. North America, Western Europe, Australia and New Zealand are particularly associated with increased deinstitutionalized mental health care.