homeless person sleeping on cardboard

Deinstitutionalization, according to Britannica, is the “movement that advocates the transfer of mentally disabled people from public or private institutions, such as psychiatric hospitals, back to their families or into community-based homes.” The movement started in the 1950s, when effective antipsychotic medications started to become available, and really took off in the 1960s and 1970s. Today, the percentage of people with severe mental illness who are hospitalized is drastically reduced, compared to the situation 70 years ago.

The topic of deinstitutionalization is fraught with controversy. Some people say that it is a good thing to refrain from confining people to institutions against their will, as much as possible. Others note, with dismay, that many people with severe mental illness are now living in jail or prison, or they are homeless on the streets.

The New Yorker ran a great article a few months ago called The System That Failed Jordan Neely, which describes the “revolving door” of homeless people with severe mental illness. The sequence of events generally goes as follows: someone displays unusual or dangerous behaviors and is picked up by the cops, who take them to the hospital, where medical teams attempt to treat them but can’t force them to stay, they insist on leaving, and they resume their life back on the streets, only to once again display alarming behaviors and be picked up by the cops and taken to the hospital.

But Jonathan Rosen, in his memoir The Best Minds, describes the situation most elegantly:

“It was one thing to recognize the terrible toll [psychiatric institutions] could take on the people inside them, and that, thanks in part to new medications, a majority of people with schizophrenia no longer needed to live there. It was something else to know what could replace the state system without destroying the idea of asylum that had given rise to it in the first place, or harming the people the system had been created to help. Hardest of all was to realize that the answers of a moment could not substitute for the slow, hard, complicated, and imperfect work of providing daily practical care for patients whose rights had finally been recognized but whose illness could itself seem like a violation of their reason and will.”

It’s a situation of desperate need and not enough resources or solutions that work.

Any thoughts?