Lessons Learned from Deinstitutionalisation in the US

• Published in: British journal of psychiatry Vol. 162; no. 5; pp. 587 - 592
• Main Author: Lamb, H. Richard
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.05.1993; RCP
• Subjects: Advanced stage; Attitude to Health; Beds; Community health care; Community Mental Health Services - organization & administration; Community Mental Health Services - standards; Deinstitutionalization; Drug abuse; Freedoms; Homeless people; Hospitalization; Humans; Lecture; Length of Stay; Medical treatment; Mental disorders; Mental Disorders - rehabilitation; Patient Admission; Patients; Quality of Health Care; Resistance; Substance abuse; United States; United States; United States > US
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.162.5.587

Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment and substance abuse are problems. Early proponents of deinstitutionalisation believed it would be cheaper, better, and give the mentally ill their freedom. In reality, good community care does not cost less. While a number of community programmes in the US have been impressive, they have served only a small proportion of the total population of severely mentally ill persons. More freedom has been of benefit for many, but has proved difficult for some patients. Some patients have been deinstitutionalised who cannot be effectively treated in the community. The homeless mentally ill epitomise all these problems.