title: Deinstitutionalization? Where have all the people gone?
abstract: Although there is broad consensus that the state psychiatric hospital population drastically declined over the past five decades, the destination and well-being of people with serious mental illness (SMI) have been in greater doubt. In this article, we examine the aftermath of the deinstitutionalization movement. We begin with a brief historical overview of the move away from state hospitals, followed by an examination of where people with SMI currently reside and receive treatment. Next, we review recent trends reflecting access to treatment and level of community integration among this population. Evidence suggests the current decentralized mental health care system has generally benefited middle-class individuals with less severe disorders; those with serious and persistent mental illness, with the greatest need, often fare the worst. We conclude with several questions warranting further attention, including how deinstitutionalization can be defined and how barriers to community integration may be addressed.
authors.affiliation: American Academy of Social Work and Social Welfare School of Social Work University of Southern California, Los Angeles, CA 90089-0411, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Davis
authors.forename: Anthony
authors.initials: A
authors.lastname: Fulginiti
authors.forename: Liat
authors.initials: L
authors.lastname: Kriegel
authors.forename: John S
authors.initials: JS
authors.lastname: Brekke
mesh_terms: D003156:Community Mental Health Services / Q000458:organization & administration* / Q000639:trends; D003688:Deinstitutionalization / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology