Deinstitutionalization is the Cause of Mass Shootings.
We Need a Rational Approach to Mental Illness.
Deinstitutionalization as a policy for state hospitals began in the period of the civil rights movement when many groups were being incorporated into mainstream society. Three forces drove the movement of people with severe mental illness from hospitals into the community: the belief that mental hospitals were cruel and inhumane; the hope that new anti-psychotic medications offered a cure; and the desire to save money.
It has not worked out as well as expected on any of the three fronts. People with severe mental illness can still be found in deplorable environments, medications have not successfully improved function in all patients even when they improve symptoms, and the institutional closings have deluged underfunded community services with new populations they were ill-equipped to handle.
Historically, state hospitals fulfilled many needs for people with severe mental illness which included therapy, medication, medical treatment, work and vocational training, and a sense of community. Prior to 1950s, it was not uncommon for state hospitals to provide a work environment. There were often workshops and farms to make or grow some of their own needs.
This was particularly true at the end of the nineteenth century before entrepreneurs realized there was a profit to be made in the state hospital system and slowly began selling goods and services to the hospitals, reducing “the amount of work and increasing the amount of idleness in the system.”
As patients were being discharged into the community, a series of legal decisions also had an impact on whether one could be readmitted or stay in a hospital setting. As early as 1866, after E.P.W. Packard was committed by her husband to an Illinois state mental institution, efforts to “reform” the system were underway. In her account of the episode, two physicians came to her home, took her pulse, and declared her insane.
She was confined for 3 years and, upon her release, led a successful campaign across the country to change the laws to safeguard people’s rights in the hospitalization process. Today every state has civil commitment laws outlining the requirements necessary to hospitalize someone with severe mental illness.
Over time, several court cases have further defined the legal requirements for admission to or retention in a hospital setting. In Lake v. Cameron, a 1966 D.C. Court of Appeals case, the concept of “least restrictive setting” was introduced, requiring hospitals to discharge patients to an environment less restrictive than a hospital if at all possible. In the 1975 case of O’Connor v. Donaldson, the U.S. Supreme Court declared that a person had to be a danger to him- or herself or to others for confinement to be constitutional.
The 1999 U.S. Supreme Court decision in Olmstead v. L.C. stated that mental illness was a disability and covered under the Americans with Disabilities Act. All governmental agencies, not just the state hospitals, were be required thereafter to make “reasonable accommodations” to move people with mental illness into community-based treatment to end unnecessary institutionalization.
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