Ethical Policy: Deinstitutionalization

Ethics Policy: Deinstitutionalization
By: Clifton Dickerson
Sunday, December 05, 2010

Deinstitutionalization has started to become a very big dilemma in our society today. Because of high recidivism and quality of care in institutions, they have started to become an unnecessary part of our mental health services. This lack of productivity in mental institutions and our recent deinstitutionalization laws has caused a lot of mental health patients to be put back out on the streets when they should be receiving treatment. These are people that can barely take care of themselves, wear torn or inappropriate clothing, talk to themselves, shout at others, and generally act in bizarre ways. Though none of this directly affects anyone personally,
it is a bad representation of our towns, state, and country. This deinstitutionalization movement soon resulted in what we call trans-institutionalization. Trans-institutionalization includes an influx of mental patients into our jails, prisons, or homeless shelters.
It is our ethical responsibility to make sure everyone in our country at least has the same opportunities as everyone else. How it is that America can claim to be an equal opportunity country, but yet there is still so many of these people wandering our streets and in homeless shelters? This is proof that these people are not able to take care of themselves and is in need of help from someone, this is where our mental institutions should come in play. Unfortunately, a lot of mental patients dread these places either because they do not believe they need help or because they do not want to have their personal rights taken away from them. Mental institutions must be able to provide patients with adequate living conditions that will further enhance their rehabilitation process. There are already a lot of rights that get taken away from a person when they are in a place they do not wish to be. The deinstitutionalization movement tried to help solve this problem by taking away institutionalization without consent by moving the mentally ill out of prolonged confinement into community mental health centers, which are voluntary. We also must think about how to finance these institutions without making the patient going in debt because of a disorder they were born with. More money will allow them to have more adequate staffing, which is also a must need in mental facilitations. This all helps keep our mental patients off of the streets wandering and helps give them adequate treatment
.
Due to the current deinstitutionalization laws, there are many of our mental patients on the streets or in jail. According to the U.S Department of Justice there have been forty new mental hospitals close in the past decade. Most of these may have been mental hospitals that were not adequately suited for patients. During that same decade there has also been four hundred new prisons that have opened up. To rectify these problems we must: 1. Educate Everyone Involved a. The prison system should be able to decipher whether a inmate has a mental illness or not b. We should have the supervisors at homeless shelters be able to refer patients to a mental hospital. To do that we need them to also be able to tell the difference between a regular homeless person and a person with a mental illness. It must be the patient’s choice to go to mental hospital though, supervisors can only refer. c. We should also make sure the employees at our mental institutions are educated on their roles in the hospital.
Deinstitutionalization helped protect the rights of mental patients, but also has been the cause of a lot of deaths of people with mental illnesses. A lot of the problems regarding people with mental illnesses on the street will cease when there are more adequate mental facilities for them to go to. The rights of patients are one of the most important factors we must consider when talking about the subject of deinstitutionalization. Like I’ve stated previously, deinstitutionalization helped solve a lot of our problems regarding the rights of patients, although there are still some we must address. How a mental facility is run has an effect on the ethics of the facility. Mental facilities should follow the following guidelines: 1. The only way a patient should be institutionalized against their will is if they are physically harming others or themselves. If they are harming themselves, then we have an ethical responsibility to help them. If there is no reason to incarcerate someone though, then it should not be done. 2. Patients should be given all of the amenities that they would receive at a state hospital. a. This includes; social services, adequate housing and food, help with employment, psychiatric care, and they should also be prepped to be able to go back out into the social world. b. To expect these patients with mental illnesses, probably without families or friends, to be able to go out and fend for themselves is preposterous. They should be taught while inside the facility how to be a responsible part of the community before they leave. 3. Patients should be given behavioral therapy first before being put on medication. This is done for a few reasons: c. To ensure that the right prescription is being handed out to patient d. I fell as if we are quick to give a patient medicine to calm them down without getting to the basics of the problem first. Therefore, we never neutralize the situation, but hide it and send them back onto the streets. e. Every patient should also continue with their behavioral therapy throughout the time there. 4. Medication will be given, at patient’s consent, in form of an implant under the skill that will slowly release medication. f. The medication period should not exceed one week. At that time adequate assessments should be made on whether to continue administering the drug to the patient. 5. Patients should have the freedom to roam around the property as they feel. g. There must, however, be cameras around the facility that is under constant surveillance to ensure the safety of the patients. 6. Every patient should have a support system while at the mental institution. h. Support system should include; psychiatrist, social worker, and nurse. i. Each one of these should know the patient on a one-on-one basis 7. Before patients are released there must be community services they can get involved in that will actually help them out and ease them into society. j. Halfway houses can be turned into production houses i. There are many jobs that a mentally ill person would enjoy doing that a normal person would not such as autonomous tasks for an autistic person. ii. By having them do this they are using what some of us call their limitations are strengths, thus building confidence and allowing them to feel like parts of the community. These production houses can also help fund these halfway houses if the profit is spent wisely in the house.
These few instructions will help make sure that the rights of all patients are taken into consideration. This way our mental institutions will not fell like prison to them, but more of an actual hospital. Doing this will help make the patients feel more comfortable being in an institution and will make them want to be here instead of out on the streets. And even when they do get out on their own, we can help make it an easier process for them. The criminal justice system is filled with mentally ill individuals, showing a failure to the deinstitutionalization movement. We must open our eyes and see the problems behind deinstitutionalization before we end up destroying the lives of innocent people with mental illnesses. This does not mean that we should shun deinstitutionalization, which was made to give patients more rights, instead just correct some of the things that it did not account for.