Lecture 26 Deinstitutionalization and Community Services: A Guest Speaker Lecture Outline I. Introduction II. Guest Speaker ------------------------------------------ I. Introduction In these lectures, we have said very little about treatment (I have left that up to your text book). Today, however, I want to take a look at one aspect of treatment, an aspect that bridges both adult and child psychopathology: the plight of the chronically mentally ill. Most of today we will reserve for our guest speaker (see below). However, let me make a few introductory comments. Beginning in the late 50's and early 60's, there was a growing realization in the professional and legal community that things were not what they should be for institutionalized patients. The size of state psychiatric hospital populations was beyond what the existing staff and funding could handle. Psychiatric hospitals were marked by staff apathy and burn-out. Patients' basic human rights were often violated. In one case, less than 50 cents per day was spent on food for each patient, and there were over 1500 patients for every psychiatrist (this was in Alabama's state hospitals, during the early 70's) (Redd, Porterfield & Anderson, 1979). As a result, there was a growing push to recognize patients' basic human rights, perhaps the most basic right being the right to live with as many freedoms as possible - or, what has been described as living in the "least restrictive environment". As a result, over the past 20 years, there has been an attempt to deinstitutionalize patients - that is, to get them back out into the community, a place that is certainly with more freedoms than one would experience in a locked ward of a state hospital. For example, in Illinois: in the 20 years from 1955 to 1975, the inpatient population dropped from 47,000 to 13,000. The flip side of the coin, unforseen by many of the original advocates of deinstitutionalization, is that many of these patients have been simply "dumped" into society (Bootzin & Acocella, 1984). The supports and programs that were supposed to help the person back into society simply are not there, or more typically are not set up to deal with the multitude of people needing the services. Example: in 1978, there were 40,000 deinstitutionalized patients in New York City; of these, 424 lived in half way houses, 2,000 others had access to sheltered workshops (Bootzin & Acocella, 1984)...but of the remaining 37,000, no one knows. These are often the homeless, the "street people" that are growing in numbers every day - it's been estimated that 25-50% of the homeless are mentally ill (Science, 12/13/85, p.1253). The fundamental problem: Who is responsible for the chronic mental patient?... Therapists? The State? The community? Today we will look at an example of a local agency that does take responsibility for people with chronic problems - developmental problems, mental illness. Many of these people can live productive lives in the community. Yet, just a mere 20 years ago, many of these people might have found themselves confined to an institution. We will see what such an agency does, as well learn about the difficulties it faces (such as the lack of funding, community support, etc). II. Guest Speaker from the Mental Health Center of Champaign County