What is deinstitutionalization and how has it contributed to the current problems of the seriously and persistently mentally ill?

Deinstitutionalization is the process by which large numbers of psychiatric-mental health clients were discharged from public psychiatric facilities over the last 40 years, with more than 90% of state hospital beds eliminated since 1960. It contributed to current problems of the seriously and persistently mentally ill because these clients were sent into communities that often lacked adequate services, and many were unable to navigate community living due to cognitive impairments such as frontal lobe pathology, poor executive function, severe memory deficits, or impaired social cognition. As a result, many became homeless, incarcerated, or inappropriately placed in nursing homes.

Deinstitutionalization, as described in the text, was the process by which large numbers of psychiatric-mental health clients were discharged from public psychiatric facilities during the last 40 years, creating an influx of seriously and persistently mentally ill clients back into the community to receive outpatient care. The process began in 1955 and accelerated with Civil Rights legislation in the 1960s and the withdrawal of federal-government financing for state-hospital clients in the 1970s. Since 1960, over 90% of state psychiatric hospital beds have been eliminated. This is identified as a major factor in the current problems of the mentally ill because these individuals may be unable to navigate the complexities of community living due to frontal lobe pathology, poor executive function, severe memory deficits, or impaired social cognition. The original plans for deinstitutionalization involved federal funding for community mental health centers, but cost shifting by the federal government to state governments led to inadequate and insufficient money for treatment, and issues of insufficiently trained personnel and funding mechanisms were not addressed. Consequently, many deinstitutionalized clients were transferred to nursing homes and other institutions, while those who did not qualify for nursing-home care were released to group homes, boarding homes, personal-care facilities, or the streets. Today, funding for aftercare community services continues to decline, leaving many individuals with SPMI living below the poverty level and barely able to meet their subsistence needs. Thus, deinstitutionalization contributed to the current problems of the seriously and persistently mentally ill by discharging them into communities unable to provide the necessary support, leading to homelessness, incarceration, and inappropriate institutionalization.