Lecture 26

                         Deinstitutionalization
                         and Community Services:
                             A Guest Speaker


Lecture Outline

I.  Introduction
II. Guest Speaker

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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