Like many moments in mental health history, today's #TBT seemed like a good idea at the time. Deinstitutionalization is the fancy way of explaining how thousands of people with mental illness were moved from mental institutions to live on the streets and in jail. Dr. E. Fuller Torrey has described it as “a psychiatric Titanic” and two Supreme Court Justices agreed with him.
Let’s revisit the scene. It was the mid-1960s and the country was in a dark place. President Kennedy had been killed, there was a deadly war in Vietnam, and civil rights protests were growing violent.
More than half a million Americans were living in mental institutions, which by all accounts were dreadful. President Kennedy had made it a priority to “combat mental illness in the United States." Not long before his assassination, he signed the Community Mental Health Act to allocate federal funds to pay for the creation of community-based preventive care and treatment facilities.
The goal was to shift costs from the state-run mental hospitals to new federally funded community mental health centers. Instead of growing old in mental institutions, patients could live in their communities, ideally with family, and receive care as needed. With the newly approved antipsychotic medications, it became easier for people with serious mental illness to manage their symptoms.
What actually happened was this: The funding for those community mental health centers never came through. Medicaid became law in 1965 but excluded coverage for people in "institutions for mental diseases.” Psychiatric hospitals began to shut down. Some patients were moved out of state mental hospitals and into more costly nursing homes or group housing where those federal funds were accepted.
Sadly, many didn’t make the transition. Experts point directly to deinstitutionalization to explain why 30% of the homeless population and 16% of inmates have a serious mental illness.
As new mental health reforms are created, it is important to remember that good intentions aren't enough. You can’t decide to throw, oh let’s say $500 million at problem today and turn your back on that issue tomorrow. We have to be committed to making changes for the long haul or risk making even bigger messes.