Mental illness is among the devastating health complications that undermine the effectiveness of the body. From a physiologic point of view, the nervous system, mainly the brain performs a central role in the coordination of all body functions which means that anything that affects its normal functioning impairs at least to some degree the normal body processes. Mental illness is synonymous with emotional illness and various from schizophrenia, post-traumatic stress disorder, trauma, bipolar disorder, dementia, depression and many others (Dixon & Goldman, 2003). The management of these mental illnesses is central to the success of any healthcare system since psychological stability contributes substantially to healing. Ideally, mental illness is not a unique or modern health complication.
Various factors including genetic, physical, and chemical may cause mental illnesses. Despite the fact that some mental illnesses such as trauma and depression may be treated successfully, some of the psychological diseases result in permanent disability (Feldman, 2003). Despite the fact that mental illness has been part of life in virtually every civilization, the scope of therapeutic interventions intended to restore normal health and the extent of psychological damage often grossly vary from one population to the next. In the past, various mythical ascription has been labeled against the mentally ill people (Dixon & Goldman, 2003). For instance, some cultures were regarded as having been cursed by God. However, over time, the understanding and response to mental illness have undergone drastic transformations. One such change is the institutionalization of the mental health response strategies and managing the sick in structured environments that respond to their dynamic needs.
Since time immemorial, the public health policies have been drafted in a way that reflects the public perceptions of the mentally ill. The public health has also been defined by a litany of cyclical reforms. In the history of the United States federal mental health policy, four reform movements have stood out significantly. The first epic informed the proper management of the mentally ill and the introduction of the asylum in the early 1800s. This phase followed the age of enlightenment (Fakhoury & Priebe, 2007). The second period coincided with the creation of the department of mental hygiene and the psychopathic health facilities. This epic followed the progressive era. The third transformation happened with the community mental health improvement. This period was marked with the 1963 Community Mental Health Centers Construction Act. It also continued into the Great Society (Fakhoury & Priebe, 2007). The fourth and current movement is yet to be delineated, but it is characterized by concerted efforts towards the correction of failures that were occasioned community mental health and deinstitutionalization. The community mental health and deinstitutionalization worked well for the mildly mentally ill but was not sufficient among the chronically mentally ill (Fakhoury & Priebe, 2007). The severely mentally ill were subject to re-institutionalization through incarceration or became homeless.
The Concept of Deinstitutionalization
In the field of sociology, the standard definition of deinstitutionalization is a paradigm shift that advocates for the deliberate transfer of psychiatric patients from the public or private health facilities such as psychiatric hospitals to their families or into the community-based health institutions (Feldman, 2003). If deinstitutionalization is not applied strictly within the context of mental health, then it may also describe similar transfers that involve prisoners, physically disabled or other individuals who were previously confined to institutions (Dixon & Goldman, 2003). Therefore, the term deinstitutionalization has been famously defined both as a government policy as well a social movement and an era.
Despite the understanding of the merits of institutionalization of mental health care, there has been a progressive deinstitutionalization that has occurred in the United States and other parts of the world. Deinstitutionalization refers to the policy in which result in the movement of severely mentally ill patients from large state managed institutions to other community-based facilities followed by a partial or full closure of the state institutions (Goodwin, 2005). Deinstitutionalization has been linked to the mental illness crisis in the United States.
In the United State of America, deinstitutionalization as a policy for state hospitals started in the epic of civil war movement. It was during this time that many victims of war were being incorporated into their mainstream communities (Feldman, 2003).There are three forces which drove the movement of people with mental illness from the hospital institutions to the community-based programs. First, there was the perception that psychiatric hospitals were not only inhumane but also cruel. Second, there was an anticipation that the new antipsychotic medications would provide a permanent cure for mental illness. Third, there was a general state desire to save money (Kelly & McKenna, 2004). However, research shows that these three forces have not worked out as perfectly as would have been expected. For instance, mentally ill patients still live in deplorable conditions, the medications have not provided a permanent cure for mental illnesses, and closing of the institutions have deluged inadequately funded community services with a new number of patients that they were unable to handle efficiently (Stiker, 2016).
The outstanding aspects of deinstitutionalization are that it has two parts. The first part involves the transfer of the mentally ill patient from state institutions. The second element is the closure of section or all of the facilities. The previous dimension results in various health challenges of the inpatients who are already mentally ill (Dixon & Goldman, 2003). The second aspect of deinstitutionalization affects the population that experiences mental illness after the commencement of policy implementation and for the long term since it results in the permanent elimination of inpatient hospital beds (Goodwin, 2005. Based on these two dimensions of deinstitutionalization, its magnitude makes it one of the most extensive social experiments to have ever been conducted in American history.
Social, Cultural, and Political Contexts of the Deinstitutionalization in the United States
The dramatic shift in how the mentally challenged people were treated emerged from the culture of the 1960s. During this time, the emerging trends deviated from the traditional conservative one of the fifties which was marked with a revolution of thought and a radical change in the general lifestyle of the American people (Novella, 2010). At this time, the rights of individuals became highly regarded as championed by the then civil rights movement and feminist movements. These revolutions attacked the beliefs and value patterns that suppressed a section of the American population (Goodwin, 2005). According to Goodwin (2005), this time was also dominated by the youth in which the baby boomer generation was moving from childhood into the teen years and young adulthood. It is thus logical to conclude that tamest these overreaching social transformation, the plight of the mentally ill received some sense of attention. This clamor for better conditions for the mentally ill patients necessitated the rejection of an institutional approach to their treatment (Feldman, 2003).
Another critical aspect of the era when deinstitutionalization emerged was the fact that there was also a great deal of change at the political level. The then president of the US, John F. Kennedy employed charisma in virtually all his political dealings (Novella, 2010). His style of leadership was very inclusive in which he at all times seemed ready to involve every America in introducing social change as a way of creating the much-needed hope for America (Goodwin, 2005). The Kennedy was always prepared to engage his government in enforcing far-reaching social change. For instance, the Community Mental Health Centers Act of 1963 reflects President Kennedys political regime clamor to foster social change (Dixon & Goldman, 2003; Feldman, 2003). The changes that were occurring in the field of mental health at the political level had started during the Second World War but increased with the activities of the Joint Commission on Mental Health and Illness (Frank, 2006). This commission further compiled a report with the government in which it found the need to reduce dependence upon hospitals for addressing mental illness challenges. It, however, recommended for the government to embrace non-traditional caregivers including caseworkers, clergy, and educators. This perspective provided support for deinstitutionalization in the following decades (Feldman, 2003).
In the 1950s America, deinstitutionalization became a popular concept taken by activists, politicians and the population at large. This concept led to a drastic reduction in the hospital population (Frank, 2006). The passage of the Medicaid and Medicare in 1966 hurried the shift if the aged mentally ill patients from the state health facilities to nursing home thus stimulating the use of community-based psychiatric services (Fakhoury & Priebe, 2007). With the growth of these community psychiatric services, they started to provide health services to populations that were not previously accessing such services. Some of these people who were receiving the services were those who were not having chronic or severe mental illness thus could not be eligible for full hospitalization (Novella, 2010). Most of the transformations in the American mental health system occurred due to the expansion services and admission of new patients and the establishment of a decentralized and heterogeneous network of services.
The History of Institutionalization and subsequent Deinstitutionalization of Mental Care
The history of mental illness interventions traces back to the 1840s when an activist called Dorothea Dix lobbied to provide better living conditions for the mentally sick. According to the activist, most of the mentally ill people faced myriads of challenges in their daily lives and were at risk of physical or emotional harm (Kelly & McKenna, 2004). It took more than forty years to convince the United States government to construct structured environments which would host the mentally disabled patients undergoing treatment and other comprehensive rehabilitative processes (Goodwin, 2005. These primordial approaches formed the basis of the institutional inpatient care model which culminated into many mentally challenged patients being admitted to state-sponsored health facilities where they had access to professional assistance (Lamb & Weinberger, 2005).
Through institutionalization of mental care, many families and community members who faced the challenge of managing their mentally ill relatives accessed such services. Despite the fact that the institutionalization of psychological acre improved patient access to mental health services, the system had to contend with new challenge including understaffing, inadequate funding which collectively attracted criticism on their sustainability (Kelly & McKenna, 2004). The poor living condition of the mentally sick coupled with multiple violations of human rights within the mental health institutions caused a clamor for deinstitutionalization of mental health care (Goodwin, 2005. Deinst...
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