Deinstitutionalization of Psychiatric Patients

by Dr. Lorin Bradbury

Several hours ago, 26 church members were murdered in cold blood in Texas, five days ago, a terrorist ran down eight people in Lower Manhattan, and just over one month ago, a crazed gunman gunned down 58 people in Las Vegas and left 546 injured. I do not know the mental state of any of these murderers, but I am very concerned that there have been a number of murders committed by individuals with known psychiatric illnesses that prior to deinstitutionalization would have been kept safe in an institution, rather than being allowed on the streets.

It’s probably time to reconsider the free for all created by deinstitutionalization and press legislators for more long-term mental health beds for the chronically mentally ill in locked facilities. Below is an article I wrote in response to a question in 2012 that helps explain the history of deinstitutionalization and the current problem it has created.

Question: Why do people that have the authority to do so keep turning mentally ill people out on the street the moment they are stabilized at API? I have a relative that I am very concerned about and I fear for her safety because she repeatedly ends up on the street. On the street, she decompensates and is then returned to API. Why do they not keep her permanently in a safe location?

During the 1950s and 1960s there was a powerful movement to deinstitutionalize psychiatric patients. There was the belief that with the advent of modern medications to treat mental problems, patients would be able to live a much more normal life outside the institution. In some cases medication has significantly improved the lives of patients suffering from a psychiatric illness and allowed them to lead a relatively normal life as long as they stay on their medication. However, in many cases the experiment has been a dismal failure.

In the past fifty years the number of state hospital beds available for chronically mentally ill patients has decreased from 600,000 to 40,000. During that same period of time, the population in the United States increased from 179,323,175 in 1960 to 308,400,408 in 2010. To put that in perspective, if the same percentage of persons with chronic psychiatric illnesses exists today, there would be a need for 1,031,881 state hospital beds. On the surface, it looks good, and those who promoted the advent of community mental health system can celebrate that there now only 40,000 state hospital beds in the United States.

Although deinstitutionalization has been positive for the many patients, the process has severe shortcomings and has produced new problems that are harder to count than hospital beds. Expectations that community mental health care would lead to greater social integration have not been achieved; many chronically mentally ill patients live impoverished lives without work, and others have been reinstitutionalized in various sheltered environments. And the uncounted number of these individuals living on the street in large cities is very evident. Most are untreated due to noncompliance with prescribed medication, and many now would meet the criteria of an additional diagnosis of a substance abuse disorder.

Even more disturbing is the fact that a Bureau of Justice Statistics study estimated there are approximately one million mentally ill individuals in prisons and jails in the United States. As a result, the nation’s largest mental health facilities are no longer psychiatric hospitals, but jails and prisons.

I was unable to locate statistics on a comparison of costs between a prison bed and a state psychiatric hospital bed. But, even if the costs were the same, when one considers the cost to the victims of the crimes committed by mentally ill individuals and the cost of adjudication far exceeds the cost of a state hospital bed. One can’t help but wonder if in the attempt to be progressive and humane, the promoters of deinstitutionalization actually created a less progressive and less humane situation.

In an article in the National Psychologist, Richard Althouse, Ph.D., Psychologist, President of the International Association for Correctional and Forensic Psychology made the following observation: “What one may conclude is that decades ago, a mentally ill individual who offended was first seen as mentally ill and then an offender and might have found treatment in a local mental health facility. The same person today would be first considered an offender then as mentally ill. They would likely not be sent to a local treatment facility; instead they would be incarcerated and, it is hoped, provided a modicum of treatment in a correctional facility. However, the chances are low.”

It is my opinion that some have benefited from deinstitutionalization and have led more productive lives. However, for the vast majority of these individuals, deinstitutionalization has not served them well.

Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected].