Morning in Mental Health: Effects of Deinstitutionalization
Photo credit @epicantus
While examining Reagan’s memorable one-minute commercial known as “Morning in America,” many thoughts came to mind. Between the seemingly perfect harmonious transitions and slideshow of delicate feel-good images which speak of an honest “day in the life” of an American, it’s easy to see how Reagan pulled on the heartstrings of many—of most, really. Turning the page from a period of financial hardship and struggle over to a “Prouder, Stronger, Better” America was a display of hope and opportunity that many were searching for and thus eager to believe in (Beschloss, 2016). Unfortunately, this push for greatness focused on prioritizing certain groups and marginalizing others.
As we discussed previously, when JFK signed The Community Mental Health Centers Act of 1963, the hope was for increased funding and widespread availability for community-based mental health centers. However, after his assassination, his plans were not fulfilled in the manner they were intended to be. This left many mental health centers struggling to stay afloat and to properly serve their clients (Placzek, 2016).
Initially, many believed that deinstitutionalization would offer a more supportive, cost-effective, and humane approach to mental health treatment (Yohanna, 2013). With the development of several new psychotropic drugs on the market, many were confident that mental health symptoms could be alleviated and that a person could safely function within his or her community. Deinstitutionalization helped many individuals receive community-based treatment alongside their family, friends, and other members of society whilst also becoming accustomed to balancing other facets of a healthy and happy life. Still, others suddenly found that they were not able to function in a less structured environment—especially if they didn’t have access to a 24/7 support system. Over time, it was apparent that there was not a one-size-fits-all approach to treating mental health conditions and many community-based centers were indeed falling short.
Moreover, it’s true that the development of several new psychotropic medications helped many individuals better manage their symptoms; however, the more severe the condition, the more powerful the drug prescribed, and therefore more likely it was for a severely mentally ill individual to live a life of emotional blunting, cognitive disruptions, and compromised motor functioning—isolated in whatever environment they could find or cycling between periods of stabilization and decompensation (Pierson, 2019).
The implementation of powerful psychotropic medications also made it difficult for individuals with a severe mental illness to remain motivated to seek community-based treatment on their own and to remain compliant with the rules and regulations of community-based programs. As a result, the introduction of community-based treatment caused many to fall through the cracks and to decline physically, cognitively, and psychologically. It was common to see an individual decompensate within the community, and soon after be admitted to a correctional, medical, or psychiatric facility where they would be stabilized, then finally be released back to the community for the cycle to repeat itself again.
Whether a result of stigmatization and victimization surrounding mental health which makes it challenging for individuals to find resources like employment, housing, and effective means of treatment, or due to the great yearning to be able to rest one’s head down at night in a place of safety and sanctuary, it’s problematic to see individuals with severe mental health conditions in nursing homes, jails, prisons, and in and out of acute care hospitals. The individual circumstances of how someone with a severe mental illness has arrived in one of the above facilities are different but the problem is the same. Our friends, family members, and neighbors are hurting and reaching out for help—in any way someone will listen.
Deinstitutionalization might have been the “solution” in the past, but it’s definitely not a clear-cut answer to accept today. Mental illness and effective treatment need to be understood on a scale—on an individual basis—and the opportunity for more comprehensive treatment options cannot be determined solely by whether or not someone is a danger to themselves or others. We must expand the framework in how we classify severe mental illness. In order to help our loved ones out of the darkness, we must first stand beside them. Morning in Mental Health acknowledges that change doesn’t happen overnight, but harmony sure can. Where will you stand?
References
Beschloss, M. (2016, May 7). The Ad That Helped Reagan Sell Good Times to an Uncertain Nation. The New York Times. https://www.nytimes.com/2016/05/08/business/the-ad-that-helped-reagan-sell-good-times-to-an-uncertain-nation.html.
Pierson, V. (2019, March 10). Hard truths about deinstitutionalization, then and now. CalMatters. https://calmatters.org/commentary/2019/03/hard-truths-about-deinstitutionalization-then-and-now/.
Placzek, J. (2016, December 8). Did the Emptying of Mental Hospitals Contribute to Homelessness? KQED. https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here.
Yohanna, D. (2013). Deinstitutionalization of People with Mental Illness: Causes and Consequences. AMA Journal of Ethics, 15(10), 886–891. https://doi.org/10.1001/virtualmentor.2013.15.10.mhst1-1310