Deinstitutionalization: An Appraisal of Reform

The number of inpatients in US public mental hospitals declined from 559,000 in 1955 to approximately 110,000 at present. Reductions resulted from release or transfer of long-term inpatients and from entrance barriers to new admissions. The timing and pace of deinstitutionalization substantially varied by state, but three quarters of the national reduction followed the expansion of welfare programs in the middle 1960s. The establishment of community care alternatives was highly inadequate, leaving many severely and persistently mentally ill people without essential services. Problems of care were exacerbated by the contraction of welfare programs in the 1980s, which resulted in serious neglect and homelessness. Plagued by underfinancing and fragmentation of care, new strategies in developing mental health care systems include capitation, case-management approaches, and the development of strong local mental health authorities.