De-institutionalization, the process of reducing long-term stay, has created much controversy in mental health. How do you feel about this historical event? Help or hindrance?
Families, caregivers, and friends hate to discuss the negativity associated with mental illness, lack of treatment available, and the loneliness that accompanies the sick and their loved ones. Various movements have resulted from this fear of discussion and the most prominent today is the “anti-stigma” and civil rights movements:
- Anti-stigma: Individuals of the anti-stigma campaigns often focus on removing negatives associated with mental illness and seeking treatment. The goal is to normalize the experience of families, friends, caretakers, and individual sufferers. Some anti-stigma supporters refuse to use the term “mental illness” but would rather use the term “mental disorder” or “mental disease.”
- Civil Rights: Supporters of civil rights in mental health are often in favor of outpatient treatment. They do not like involuntary commitment to psychiatric hospitals. Supporters believe it is against the civil rights of individuals to be hospitalized against their will. This view has become very problematic within the mental health system.
The foundation of these movements can ultimately pose great challenges to families and caregivers seeking treatment, especially in cases of severe mental illness.
The exodus or departure of patients during the mid-1960s to the early 1970s led to what is known today as de-institutionalization. This led to the removal of severely mentally ill or under-treated individuals from state hospitals and into society where incarceration, violence, victimization, and homelessness became a frequent reality.
While this movement was intended to provide autonomy, it led to chaos, lack of treatment, and little to no aftercare. There are two important issues that families and caretakers are unformed about:
1.) Modification of the system
The so-called de-institutionalization reform was influenced by many, but also the advocacy of two lawyers: Bruce Ennis and Thomas Zander. Ennis, who died in 2000, was a 1st Amendment “expert” and national legal Director of the American Civil Liberties Union. He spent several years directing the Mental Health Law Project, which focused on fighting for the constitutional rights of mental health patients. It is important that we understand the deep issues inherent in mental health care, which is something Ennis did not consider at the time he pushed for constitutional rights for those institutionalized.
As E. Fuller Torrey, MD (2008) quoted in his book The insanity offense: How America’s failure to treat the seriously mentally ill endangers its citizens, “Ennis’s avowed goal was nothing less than the abolition of involuntary hospitalization and the ultimate closure of all mental hospitals.” Torrey believes that deinstitutionalization has contributed to the majority of the homeless, incarcerated, victimized, and dangerous in our society today. I am of the firm belief that restrictive laws have led to reduced access to proper care and negative consequences in our communities such as:
- poorly enforced treatment options such as Assisted Outpatient Treatment,
- short stays in psychiatric hospitals, and
- difficulty with involuntary commitment in severe but not lethal cases.
For example, a mother who has a son with severe bipolar disorder and abusing substances could not be committed to a psychiatric hospital unless he was a danger to himself or others. In other words, he must be on the brink of death before he could be committed.
2.) Introduction of psychiatric medication
Due to the advent of psychotropic drugs, de-institutionalization appeared genius. This was the beginning of tragedy for many. The introduction of anti-psychotics such as Lithium or Haldol contained severe symptoms and allowed most to live with reduced chaos. This helped support the view that inpatient care could become a last resort choice. But strict legal criteria for being committed have created barriers. There are times when restriction is appropriate to protect the individual and others.
As a supporter of outpatient and less restrictive care, I encourage you to consider options that best suits your situation. But I also encourage families to seek inpatient care, residential care, and hospitalization if strict monitoring is needed. To reduce negative consequences, inpatient care is often needed for people likely to end up in bad scenarios.
The purpose of hospitalization is stabilization, not imprisonment. Once we open our mind to the full purpose of involuntary commitment and assisted outpatient treatment, we can possibly offer the flexibility that families and caretakers of the severely ill desire.
All the best
A recent incident in Pittsburgh spurs action: WPXI
To watch a video by E. Fuller Torrey, visit my site: Anchored-In-Knowledge
Cerny,C. 2009). The insanity offense: How American’s failure to treat the seriously mentally ill endangers its citizens. Journal Of The American Academy Of Psychiatry And The Law Online 37(2), 275-277. (attach to post: http://www.jaapl.org/content/37/2/275.full)
Los Angeles Times. (2000). Bruce J. Ennis; ACLU lawyer argued Supreme Court Cases. Retrieved February 24, 2013, http://articles.latimes.com/2000/aug/03/local/me-63749.
PBS Frontline. (2005). Deinstitutionalization: A psychiatric “Titanic.” Retrieved February 24, 2013, from http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.
YouTube. (2009, May, 4). Book TV: E. Fuller Torrey “The Insanity Offense.” Retrieved February 25, 2013 from, http://www.youtube.com/watch?feature=endscreen&v=gwnO2hkei2Q&NR=1.