Deinstitutionalization in the United States

from treatment innovations of the period: models of milieu treatment and aftercare programs that appeared to offer practical alternatives to long-term custodial care [3]. Changes in psychosocial treatment, coupled with the introduction of neuroleptic medications, permitted the first large-scale changes in the public hospital system. In 1955, the resident census in state and county psychiatric hospitals began the steady decline that has persisted into the present. Deinstitutionalization, in its most literal sense, had begun. In 1963 the United States Congress passed the Community Mental Health Centers Act and instituted the first national policy of community care for the mentally ill. This legislation established community mental health centers to provide a standard range of local services in selected federal catchment areas throughout the United States. The goals of community care were ambitious, going far beyond the notion of hospital reform. They included not merely the relocation of the mentally ill in more humane settings but the rehabilitation of psychiatric patients and their reinsertion into society. They emphasized prevention of the behaviors associated with longterm hospitalization and, through this, eventual elimination of the