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In 1955 there were 559,000 patients in public mental hospitals in the USA, the highest there had ever been. At that time, patients were largely committed involuntarily and had long hospital stays. For more than a century, the number of patients at state institutions, historically the primary facilities for the treatment of psychiatric disorders, had been rising steadily. By 1980, however, this number had declined to just over 132,000, despite the fact that the national population grew considerably. In 2003, fewer than 53,000 remained. The 93 percent drop in the resident census of state hospitals was accompanied by the growth of outpatient clinics and community mental health centers as primary care facilities, the sharp reduction in patients’ average length of hospitalization, and the shift to policies emphasizing more voluntary admissions.
These statistics, however, did not reflect a precipitous reduction in the number of seriously mentally ill persons. What took place, especially from 1965 to 1980, was a transfer of patients from state institutions to a range of institutional settings such as nursing homes, board-and-care facilities, halfway houses, and community treatment centers. This massive and unprecedented patient relocation from hospital to community, termed ”deinstitutionalization” by both social scientists and the mass media, was supported by certain ideologies and political actions.
In the 1980s and 1990s, one of the most important unintended consequences of deinstitutionalization was the dramatic increase in the homeless population. Inexpensive housing in large cities was unavailable and many discharged mental patients simply had no place to go and ended up living on the streets, in alleyways, or in subway caverns with other homeless people. As early as 1984, the American Psychiatric Association proclaimed that deinstitutionalization was a failure and a major social tragedy.
- Bachrach, L. L. (1996) Deinstitutionalization: promises, problems, and prospects. In: Knudsen, H. C. & Thornicroft, G. (eds.), Mental Health Service Evaluation. Cambridge University Press, Cambridge, pp. 3-18.