Deinstitutionalization: Its Impact on Community Mental Health Centers and the Seriously Mentally Ill.

Abstract

Deinstitutionalization has had a significant impact on the mental health system, including the client, the agency, and the counselor. For clients with serious mental illness, learning to live in a community setting poses challenges that are often difficult to overcome. Community mental health agencies must respond to these specific needs, thus requiring a shift in how services are delivered and how mental health counselors need to be trained. The focus of this article is to explore the dynamics and challenges specific to deinstitutionalization, discuss implications for counselors, and identify solutions to respond to the identified challenges and resulting needs. State run psychiatric hospitals have traditionally been the primary component in the treatment of people with severe and persistent mental illness. For many years, individuals with severe mental illness (SMI) were kept out of the community setting. This isolation occurred for many reasons: a) the attitude of the public about people with mental illness, b) a belief that the mentally ill could only be helped in such settings, and c) a lack of resources at the community level (Patrick, Smith, Schleifer, Morris & McClennon, 2006). However, the institutional approach was not without its problems. A primary problem was the absence of hope and expectation that patients would recover (Patrick, et al., 2006). In short, institutions seemed to become warehouses where mentally ill were kept for long periods of time with little expectation of improvement. In 1963, the Kennedy administration addressed the institutionalization of the severely mentally ill and the condition of state mental hospitals. The result was the passage of the 1963 Community Mental Health Centers Act (CMHCA). The CMHCA had a tremendous impact on the mental health system in the United States and upon the profession of mental health counseling. This act not only restructured how services were provided but also who performed those services. No longer was treatment restricted to the medical professionals. Therapeutic services to the SMI were now relegated to a host of non-medical professionals. Previous to the CMHCA, mental health counselors were primarily working with people who were struggling with issues such as marital conflict or developmental issues, but who were essentially healthy (Browers, 2005). Individuals with SMI, especially if it were persistent, were placed in hospitals and dealt with at the institutional level. However, the development of the first antipsychotic medication in 1954 opened the door for community-based treatment rather than lifelong institutionalization (Stubbs, 1998). The CMHCA legislation brought people into the community who exhibited more significant symptoms of mental illness, thus creating new challenges for the mental health system at the community level, as well as for mental health counselors. Social, Cultural, and Political Context of the Deinstitutionalization It should not be surprising that such a dramatic shift in approach for treating individuals with SMI should emerge from the culture of the 1960‘s. The culture was distinct from the conservative lifestyle of the fifties and there was a revolution of thought and a radical shift in the framework of American life. This was a time