Hostname: page-component-55f67697df-jr75m Total loading time: 0 Render date: 2025-05-11T00:00:38.599Z Has data issue: false hasContentIssue false
  • English
  • Français

Lessons Learned from Deinstitutionalisation in the US

Published online by Cambridge University Press:  02 January 2018

H. Richard Lamb
H. Richard Lamb*
Affiliation:
University of Southern California School of Medicine, USC Department of Psychiatry, 1934 Hospital Place, Los Angeles, CA 90033, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment and substance abuse are problems. Early proponents of deinstitutionalisation believed it would be cheaper, better, and give the mentally ill their freedom. In reality, good community care does not cost less. While a number of community programmes in the US have been impressive, they have served only a small proportion of the total population of severely mentally ill persons. More freedom has been of benefit for many, but has proved difficult for some patients. Some patients have been deinstitutionalised who cannot be effectively treated in the community. The homeless mentally ill epitomise all these problems.

Type
Lecture
Information
The British Journal of Psychiatry , Volume 162 , Issue 5 , May 1993 , pp. 587 - 592
Copyright
Copyright © Royal College of Psychiatrists, 1993 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Bachrach, L. L. (1978) A conceptual approach to deinstitutionalization. Hospital and Community Psychiatry, 29, 573–578.Google ScholarPubMed
Bachrach, L. L. (1984) Asylum and chronically ill psychiatric patients. American Journal of Psychiatry, 141, 975–978.Google Scholar
Carling, P. J., Miller, S., Daniels, L., et al (1987) A state mental health system with no state hospital: the Vermont feasibility study. Hospital and Community Psychiatry, 38, 617–623.Google ScholarPubMed
Dorwart, R. A. (1988) A ten-year follow-up study of the effects of deinstitutionalization. Hospital and Community Psychiatry, 39, 287–291.Google Scholar
Gudeman, J. & Shore, M. (1984) Beyond deinstitutionalization. New England Journal of Medicine, 311, 832–836.Google Scholar
Harris, M. & Bergman, H. C. (1987) Differential treatment planning for young adult chronic patients. Hospital and Community Psychiatry, 38, 638–643.Google Scholar
Hopper, K., Baxter, E. & Cox, S. (1982) Not making it crazy: the young homeless patients in New York City. In New Directions for Mental Health Services Number 14 (eds Pepper, B. & Ryglewicz, H.), pp. 33–42. San Francisco: Jossey-Bass.Google Scholar
Lamb, H. R. (1979) The new asylums in the community. Archives of General Psychiatry, 36, 129–134.Google Scholar
Lamb, H. R. (1982) Young adult chronic patients: the new drifters. Hospital and Community Psychiatry, 33, 465–468.Google Scholar
Lamb, H. R., (ed) (1984) The Homeless Mentally III. Washington, DC: American Psychiatric Association.Google Scholar
Lamb, H. R. (1988) Deinstitutionalization at the Crossroads. Hospital and Community Psychiatry, 39, 941–945.Google ScholarPubMed
Lamb, H. R. & Mills, M. J. (1986) Needed changes in law and procedure for the chronically mentally ill. Hospital and Community Psychiatry, 37, 475–480.Google Scholar
Lamb, H. R. & Mills, M. J. & Peele, R. (1984) The need for continuing asylum and sanctuary. Hospital and Community Psychiatry, 35, 798–802.Google Scholar
Lamb, H. R. & Mills, M. J. & Peele, R. & Talbott, J. A. (1986) The homeless mentally ill: the perspective of the American Psychiatric Association. Journal of the American Medical Association, 256, 498–501.Google Scholar
Marcos, L. R., Cohen, N. L., Nardacci, D., et al (1990) Psychiatry takes to the streets: the New York City initiative for the homeless mentally ill. American Journal of Psychiatry, 147, 1557–1561.Google Scholar
Minkoff, K. (1987) Beyond deinstitutionalization: a new ideology for the postinstitutional era. Hospital and Community Psychiatry, 38, 945–950.Google Scholar
Minkoff, K. & Drake, R., (eds) (1991) Dual diagnosis of major mental illness and substance disorder. New Directions for Mental Health Services. Number 50. San Francisco: Jossey-Bass.Google Scholar
Pepper, B., Kirshner, M. & Ryglewicz, H. (1981) The young adult chronic patient: overview of a population. Hospital and Community Psychiatry, 32, 463–469.Google Scholar
Talbott, J. A. & Lamb, H. R. (1984) Summary and recommendations. In The Homeless Mentally Ill (ed. Lamb, H. R.), pp. 1–10. Washington, DC: American Psychiatric Association.Google Scholar
Thornicroft, G. & Bebbington, P. (1989) Deinstitutionalisation - from hospital closure to service development. British Journal of Psychiatry, 155, 739–753.Google Scholar
Van Putten, T., Crumpton, E. & Yale, C. (1976) Drug refusal in schizophrenia and the wish to be crazy. Archives of General Psychiatry, 33, 1443–1446.Google Scholar
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative to mental hospital treatment: economic benefit-cost analysis. Archives of General Psychiatry, 37, 400–405.Google Scholar
Wing, J. K. (1986) The cycle of planning and evaluation. In The Provision of Mental Health Services in Britain: The Way Ahead (eds Wilkinson, G. & Freeman, H.). London: Gaskell/Royal College of Psychiatrists.Google Scholar
Wing, J. K. (1990) The functions of asylum. British Journal of Psychiatry, 157, 822–827.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.