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  •  Deinstitutionalization (2+ / 0-)
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    chantedor, mkor7

    You've caught a big piece of the issue. In the 1970's and 1980's, a combination of social awareness of the awful institutions (a genuine problem, but as you point out, not a universal one) and the dawn of the budget austerity movement on the right wing combined to lead to a series of court decisions and legislation which made it legally impermissible to institutionalize a mental patient in any but the least-restrictive format possible consistent with keeping them from harming themselves or someone else. The idea on the part of the folks who were genuinely concerned with the patients' treatment was that they would be treated in halfway houses and at home with community support, and they genuinely tried to make that possible, but the budget austerity people took advantage of the opportunity and cut those measures, leaving no option which offered real treatment (or even adequate supervision) at all. People would be decreed non-hospitalizable because they were stable if they took their medication, for example, but there would be no way to make them take their medication because there was no supervision available to offer them in the community, and so they would stop, and go psychotic and attack someone.

    On top of that, when there were too few people who were hospitalized under the stricter rules, it became economically inefficient to keep the hospitals open, and they shut down, meaning that there was noplace to put even the people who truly couldn't be let loose in the community without hurting themself or someone else. At this point you're exactly right: there is nothing except drugs (either self-medicating with street forms or, for the lucky, prescriptions that family members can help them maintain) at home or prison. The prison system is really the only place where long-term mental health treatment is possible anymore, which is why the mother in the article I cited was told by a realistic social worker to get her son convicted of a crime if she wanted him to get any form of real treatment. But it's hardly a better solution than the old hospitals, even though that was an imperfect one in its own way.

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