Manual Worlds of the mentally ill: how deinstitutionalization works in the city

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The CMHCs have proven woefully inadequate at caring for this massive population. They offer far less supervision, professional care, and patient coordination than the old state institutions did. Also, with an eye on the bottom line, the managed-care companies that run them generally avoid taking on costly patients with severe illnesses. For evidence of the failure of the CMHCs, just look at the way so many mentally ill people actually live today. Deinstitutionalization has consigned them to a terrifying roller-coaster ride among prisons, emergency rooms, and the streets.

Public psychotic episodes, now a common sight in American cities, are, at the very least, frightening examples of the loss of social order. Last year, a New York homeless man made headlines when he was caught on video making angry outbursts in front of children.

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The behavior earned him a profile in the New York Times , which revealed that he had once operated a pornographic website in Cambodia called Welcome to the Rape Camp. Days later, he was back in costume, posing with children for money. F ar more frightening than episodes like that is the violence that a small percentage of the severely mentally ill inflict on society. The list includes Seung-Hui Cho, who in killed 32 and injured 24 at Virginia Tech; Jared Lee Loughner, a diagnosed schizophrenic who in killed six people and injured 14, including U.

Representative Gabrielle Giffords; and possibly James Holmes, who is currently awaiting trial for opening fire in on a crowded movie theater in Aurora, Colorado, killing 12 and injuring at least Psychotic breakdowns on a smaller scale pose an even greater public concern. A study in Indiana found that 10 percent of inmates imprisoned for homicide had been diagnosed with severe mental illness, a number consistent with similar studies in Europe.

In , Andrew Goldstein, a schizophrenic who had stopped taking his medications, shoved Kendra Webdale to her death beneath a train in New York City. This past December, a homeless drifter named Naeem Davis was seen exhibiting erratic behavior on a subway platform before allegedly shoving Ki-Suck Han onto the tracks and killing him. Later that month, Sunando Sen was killed the same way. These incidents suggest a correlation between deinstitutionalization and violent crime, a relationship that Torrey and others confirm.

The connection between mental illness and crime would come as no surprise to law enforcement professionals. Yes, expensive institutional beds have been eliminated. But weigh those savings against the costs that must be borne by other facilities, such as emergency rooms, prisons, jails, and nursing homes. But even more important is the human cost of preventing sick people from receiving proper treatment. Society has an obligation to save people from degradation, not just death. W hile the backers of deinstitutionalization recognize these problems, they have largely doubled down on their own solution, calling for even more funding of the poorly managed local facilities that replaced the asylums.

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But recently, a few psychiatrists and other members of the mental health profession have joined urbanists and law enforcement officials in questioning the wisdom of deinstitutionalization. Last April, H. Moffic went on to praise recent expansions at a handful of psychiatric hospitals in Massachusetts and Vermont. The tide, he said, was turning back toward the institutions.

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Moffic I do not look back with horror at my work in the institution, but with some fondness. Give them asylum for as long as they need it. S ixty years ago, Jo Garfield took asylum exactly that way. Battling a severe eating disorder and underlying manic-depressive symptoms, Garfield was anorexic at 16, grew to pounds a year later, and became addicted to the prescription drug Dexedrine. At college in Wisconsin, after she stole a prescription pad and filled her scripts at drugstores, her mental state deteriorated further.

Her parents sent her to Chestnut Lodge, a small private mental institution in Rockville, Maryland. She willingly extended her initial treatment of a few months to a few years. Garfield spent two and a half years at Chestnut Lodge. They had arts and crafts. A newspaper.

On the floor I started out was the less seriously disturbed, but it was a locked ward. Then once they decided I could be trusted not to get pills, they moved me to this smaller thing called Little Lodge. There was a lot of bridge playing.


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I got involved in this small store. Now I had changed my habits. I had retrained myself. He read at age two, asked to study cello at four, and entered a preeminent music school at Mel was as good at math and English as at music. Yet soon after he enrolled in college, his eccentricities became more pronounced. Sometime after his return, I learned that he had been diagnosed with schizophrenia.

He drifted among flophouses in Trenton, New Jersey.

Understanding psychiatric institutionalization: a conceptual review | BMC Psychiatry | Full Text

By phone, we talked about his difficulty taking antipsychotic medication; he felt much better without it, he said. Soon after the terrorist attacks of September 11, , Mel left a message on my answering machine to say hello—one in a series of calls that he made to friends, as I later learned.

Two days later, he jumped to his death from a New York high-rise. He was E ven as more critics come forward, deinstitutionalization continues. In , nearly , severely mentally ill patients were in the care of state psychiatric hospitals. By , only 43, state psychiatric beds remained available for the mentally ill.

That equals about 14 psychiatric beds per , Americans, far fewer than the minimum of 50 recommended by TAC and nearly identical to the per-capita number that existed in , when the institutional movement first began.


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  8. A century and a half ago, the need for a moral treatment of the mentally ill led to institutions that offered the most advanced care of the day. The fiscal and legal barriers to repeating that achievement may seem insurmountable. James Panero is the managing editor of The New Criterion , where he writes about art every month. His Twitter handle is jamespanero. Send a question or comment using the form below. This message may be routed through support staff.

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    Hodgins Ed. Newbury Park , CA : Sage pp. Stricevic Vuka Swanson, J. Tetlow Gemma. Thakker Y. Torrey E. Stieber, J. Housing models for alcohol programs serving homeless people. Contemporary Drug Problems , 16, The International Journal of Psychosocial Rehabilitation Deinstitutionalization or Disowning Responsibility 'The more things change, the more they remain the same. Sheth HC. Deinstitutionalization or Disowning Responsibility. Vol 13 2. These problems can be solved by building more mental hospitals of a small size with an open ward facility and rehabilitation center; providing employment to mentally ill patients, building more halfway homes, quarter way homes, daycare centers, sheltered workshops; providing a housing facility to the improved patients; establishing the special courts which deals with the cases pertaining to mentally ills on a preferential bases and along with it enacting the laws to protect rights of mentally ill patients.

    The policy of was deinstitutionalization was started in mid In , it was believed that state mental hospitals were too often institutions for quarantining the mentally ill. On Oct. The policy was said to be initiated by concern for mentally ill patients. But economic consideration was not rule out. However policy of deinstitutionalization has failed miserably. Here I have tried to discuss that how deinstitutionalization movement is affecting the mentally ill patients in both developing as well as the developed countries alike.

    Problems Deinstitutionalization or Trans-institutionalization : A n estimated 4. And out of 4.

    And one of the reasons for this condition is a failure of the deinstitutionalization policy Fact Sheet, Treatment Advocacy Centre. In Oklahoma researchers are examining whether there is a correlation between the growing number of suicides and the downsizing of the state mental hospital Borenstein, According to him thousands of mentally ill patients are being dumped out of state hospitals into communities that do not have the adequate services to receive them.

    These efforts known as "the deinstitutionalization movement", has resulted in trans-institutionalization, in which huge numbers of mentally ill individuals lands in jails, prisons, homeless shelters, and flop houses.