Deinstitutionalization and the Homeless

It is nearly impossible to walk between any two points in New Haven without being affected in some small way by our city’s homeless problem. On seeing these people, in many cases, it becomes clear that they suffer from some mental disability that, unaided, will obviously impede their living a normal life. In fact, according to the Report of the Federal Task Force on Homelessness and Severe Mental Illness, one in every three homeless people suffers from a severe mental illness, most of which are treatable. In a country that devotes so many resources to various welfare programs for nearly every group, how can this problem persist? The answer to this question lies in a major national policy shift, deinstitutionalization, which occurred progressively between 1960 and 1980. Though deinstitutionalization addressed a necessary problem, in practice, it only worsens the problems facing the mentally disabled and society at large. What prevailing social ideas and changes brought an end to our nation’s established system of state psychiatric hospitals? What is the logic behind our new and inefficient system of community centered outpatient mental health?

Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation’s state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.

Around the middle of the last century though, huge developments were made in treating many mental illnesses, which until then had largely been life-long problems. This change made many organizational hospital practices used to insure order and asylum to patients no longer fully necessary. These practices seemed inhumane and excessive on the promise that emerging science could provide alternative treatments to indefinite hospitalization. One huge development that helped turn public opinion against institutionalization of the mentally ill was the introduction of the prefrontal leukotomy. Widely attributed to Portuguese psychiatrist and statesman Dr.