Deinstitutionalization and Homelessness

Rabbi Azriel Hauptman

Homelessness is a growing problem in the United States and as of 2018 over half a million people were homeless. Of those, about 200,000 homeless people suffer from mental illness such as bipolar disorder or schizophrenia. Amongst the prison population, it is estimated that approximately 300,000 inmates in the United States are suffering from mental illness. It didn’t used to be this way. There used to be government-run “ insane asylums ” that provided long-term or lifelong care for individuals with severe mental illness. In the 1950s, there were over half a million beds nationwide in these institutions. This article will explore the causes of the closing of these institutions and what it means for us today. Before we begin, we must note that until the 1950s there were no medications at all for treating mental illness and therefore the presentation of an individual living with chronic mental illness bears no resemblance to what we see today. The advent of medications that can treat psychotic disorders and other mental illness has transformed the landscape of psychiatric disorders. In the 16th and 17th centuries, we begin to find a rise in institutions that housed individuals with mental illness. The costs were covered by families, who were often too ashamed to have the individual living with them. Patients were often restrained with shackles, and abuse and neglect were rampant.

In the 19th centuries, the public began to recognize the abuse that occurred in these facilities, and many asylums started to treat their residents more humanely and shackles became less common. At this time, we start finding the creation of government-run institutions. These buildings tended to be majestic and therapeutic. Additionally, many were located on large grounds where residents could take walks and even tend the gardens. Nevertheless, many abuses remained. Overcrowding was rampant, and this led to poor living conditions, lack of hygiene, abuse of residents, and even starvation. In the 1950s, partially as a result of the publicity of the horrific conditions in these institutions, the sentiment of the public changed dramatically. Until that point, it was common to believe that mentally ill individuals should live out their lives in an institution. Additionally, at this time medications were discovered that were able to treat many individuals who until then were considered untreatable, and governments became unwilling to pay for the high cost of life-long institutional care. A movement, known as deinstitutionalization, emerged that called for the closing of the long-term care facilities and treating patients through short-term stays in the hospital, home-based treatments, and halfway houses that helped them integrate into society.

Deinstitutionalization has its pros and cons. The pros are that rather than having society send the mentally ill into lifelong institutions, they were forced to develop ways to treat them in their home environment and to allow them the opportunity to be a productive member of society. New legislation that made it extremely difficult to commit someone against their will meant that individuals struggling with mental illness did not have their rights stripped from them. The cons are that there is a subset of individuals who need more help than just a few weeks in a hospital or a halfway house and their needs are not being met. The result has been a sharp rise in the homeless and prison population. As a society, we have made tremendous strides in the care of mental illness. However, we still have a long way to go. Innovative ideas are needed to develop interventions that have the best of both worlds; allowing every human being to maintain their dignity and self-respect, and interventions that can treat and care for individuals with severe mental illness.

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