Deinstitutionalization In The Prison System

Beginning in the 1950’s, the United States started deinstitutionalization state mental institutions. The plan was to move them out of the hospital and into a community based program. However, today the biggest depository for the severely mental ill is the Criminal Justice system. About ten percent of the population has sort of psychiatric illness that landed them in jail. In many ways the prison system is acting as a replacement for mental institutions and there are probably more people in jail than in hospitals. Incarceration is costly, unhealthy and unhelpful. To solve the issue we need to refocus on the original goals of deinstitutionalization and provide better care which should be more humane, therapeutic and cost effective. Programs
Deinstitutionalization can however have multiple definitions; the first focuses on reducing the population size of mental institutions. Releasing individuals from institutions, shortening the length of their stay, and reducing both admission and readmission can accomplish this. The second definition refers to reforming mental hospitals' institutional processes so as to reduce or eliminate reinforcement of dependency, hopelessness, learned helplessness, and other maladaptive behaviors. The United States has gone through two episodes of deinstitutionalization. The first was during the 1950s and the second during President John F Kennedys reign. The passing of the National Mental Health Act was one of Kennedy’s last signed laws in 1963. This act was for “centers to facilitate early identification of symptoms, provide preventative treatment which would diminish the incidents of mental disorders and long-term hospitalization” (Grob, 1995). Later a third definition of deinstitutionalization came about. “In the 1970s it had a positive connotation: the term referred to the discharge of long-term psychiatric patients from obsolete custodial mental hospitals that had seemingly outlived their usefulness” (Grob,
For many examples and many errors were made along the way, studies eventually showed that the mentally ill could still be independent while participating in a group therapy or half way housing. One example is the reaction the court systems started to see since the 1960’s. “The identifications of these new legal issues had significant consequences for psychiatrists and the mentally ill“ (Grob, 1995). In other words, the concern was with patient rights. “The courts defined the right to treatment in a least- restrictive environment, shortened the duration of commitment and placed restraints on the application process” (Grob, 1995). With this trend it was seen that patients were discharged quicker from mental hospitals with the belief that community based care and treatment plans would be more beneficial to the patient. This was the start of federal Medicare and Medicaid, which started in 1965. Medicaid and Medicare were created with coverage for a range of services including components of the mental health continuum. “Medicaid coverage of general hospital psychiatric services, coupled with an exclusion of coverage for individuals in institutions for mental diseases such as state hospitals, led to the addition of a significant number of acute care beds in the community for psychiatric patients” (Grob,