Deinstitutionalization and Community Care: Social Welfare Policy as Mental Health Policy

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Has deinstitutionalization failed, and if so, is it a failure of mental health policy—or of something else? Numerous articles1-5 in the news media and professional literature in the United States and the United Kingdom seem to reflect a public conclusion that the dual mental health policies of deinstitutionalization and community care are inadequate. The evidence offered includes high rates of homelessness among persons with mental illness and incidents of violence attributable to individuals having a history of contact with the mental health service system. Also cited are the confinement of disproportionate numbers of mentally ill persons in jails and nursing homes, the failure of individuals with a history of mental illness to participate in the work force, and the specter of discharged patients “smoking and rocking away their days” in quiet desperation in board-and-care homes or their own apartments.

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