This volume will examine deinstitutionalization’s legacies approximately 50 years after reintegration began. It will highlight pressing issues around mental health treatment, social and health policy, and the lived experiences of those coping with mental illness that were or continue to be significantly influenced by deinstitutionalization reforms.
In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to impact mental health care. Though he never publicly acknowledged it, the program was a tribute to Kennedy's sister Rosemary, who was born mildly retarded and developed a schizophrenia-like illness. Terrified she'd become pregnant, Joseph Kennedy arranged for his daughter to receive a lobotomy, which was a disaster and left her severely retarded. Fifty years after Kennedy's speech, E. Fuller Torrey's book provides an inside perspective on the birth of the federal mental health program. On staff at the National Institute of Mental Health when the program was being developed and implemented, Torrey draws on his own first-hand account of the creation and launch of the program, extensive research, one-on-one interviews with people involved, and recently unearthed audiotapes of interviews with major figures involved in the legislation. As such, this book provides historical material previously unavailable to the public. Torrey examines the Kennedys' involvement in the policy, the role of major players, the responsibility of the state versus the federal government in caring for the mentally ill, the political maneuverings required to pass the legislation, and how closing institutions resulted not in better care - as was the aim - but in underfunded programs, neglect, and higher rates of community violence. Many now wonder why public mental illness services are so ineffective. At least one-third of the homeless are seriously mentally ill, jails and prisons are grossly overcrowded, largely because the seriously mentally ill constitute 20 percent of prisoners, and public facilities are overrun by untreated individuals. As Torrey argues, it is imperative to understand how we got here in order to move forward towards providing better care for the most vulnerable.
America started a grand experiment in the 1960s: deinstitutionalization of the mentally ill. The consequences were very destructive: homelessness; a degradation of urban life; increases in violent crime rates; increasing death rates for the mentally ill. My Brother Ron tells the story of deinstitutionalization from two points of view: what happened to the author's older brother, part of the first generation of those who became mentally ill after deinstitutionalization, and a detailed history of how and why America went down this path. My Brother Ron examines the multiple strands that came together to create the perfect storm that was deinstitutionalization: a well-meaning concern about the poor conditions of many state mental hospitals; a giddy optimism by the psychiatric profession in the ability of new drugs to cure the mentally ill; a rigid ideological approach to due process that ignored that the beneficiaries would end up starving to death or dying of exposure.
This vital addition to carceral, prison, and disability studies draws important new links between deinstitutionalization and decarceration Prison abolition and decarceration are increasingly debated, but it is often without taking into account the largest exodus of people from carceral facilities in the twentieth century: the closure of disability institutions and psychiatric hospitals. Decarcerating Disability provides a much-needed corrective, combining a genealogy of deinstitutionalization with critiques of the current prison system. Liat Ben-Moshe provides groundbreaking case studies that show how abolition is not an unattainable goal but rather a reality, and how it plays out in different arenas of incarceration—antipsychiatry, the field of intellectual disabilities, and the fight against the prison-industrial complex. Ben-Moshe discusses a range of topics, including why deinstitutionalization is often wrongly blamed for the rise in incarceration; who resists decarceration and deinstitutionalization, and the coalitions opposing such resistance; and how understanding deinstitutionalization as a form of residential integration makes visible intersections with racial desegregation. By connecting deinstitutionalization with prison abolition, Decarcerating Disability also illuminates some of the limitations of disability rights and inclusion discourses, as well as tactics such as litigation, in securing freedom. Decarcerating Disability’s rich analysis of lived experience, history, and culture helps to chart a way out of a failing system of incarceration.
The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough. In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage. The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The "mainstreaming" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.
This book focuses on the intersection of place and overall community health thereby focusing on some of the most critical contemporary social problems, including the opioid crisis, suicide, socioeconomic status and ethnicity, mental illness, crime, homelessness, green criminology, and social and environmental justice. Scholars from a variety of disciplines, including geography, sociology, criminology, mental health, social work, and behavioural sciences discuss the importance of geography in our quality of life. Each chapter introduces the reader to an overview of the topic, presents theoretical frameworks and the most recent empirical evidence, and discusses real world policy implications. As such this book is a key resource for researchers, policy makers, and practitioners working in the field.
Is residential care 'inherently harmful'? This book argues that this conventional wisdom is wrong and is, itself, harmful to a significant number of children and youth. The presumptive view is based largely on overgeneralizations from research with infants and very young children raised in extremely deprived environments. A careful analysis of the available research supports the use of high-quality residential care as a treatment of choice with certain groups of needy children and youth, not a last resort intervention. The nature of high-quality care is explored through child development theory and research and two empirically supported models of care are described in detail. It will be of interest to all scholars and students of child development, child welfare, youth work, social work and education as well as professionals working within these fields.
Human service programming has been the focus of much public scrutiny, legislative action, and applied research in recent years. As a result, human service providers have learned to exhibit greater respect for the needs and legal rights of their consumers, the appropriateness and cost effectiveness of treatment procedures and service programs, and the per sonnel and facilities involved in providing services to consumers. Despite this encouraging trend, many human service agencies are still trying unsuccessfully to meet the two fundamental criteria of effec tive programming: (1) providing services that are effective in meeting the needs of the consumer and (2) equipping consumers to function indepen dently of the human service system to the extent possible. For example, there appears to be a general acceptance of the notion that custodial institutional service programs are needed, despite the fact that they are ineffective in rehabilitating and transitioning clients to the community and that they are difficult to change. In addition, although community based service programs have been developed as alternatives to institu tional placement, there is rarely sufficient transitional planning and pro gramming to facilitate the client's progress from the institution to the community. Although these problems generally are acknowledged, most human service managers and practitioners are ill equipped to deal with them. Specifically, the technology of human service management is in need of improvement. It is more theoretical than practical, and it lacks sufficient field testing and empirical validation.
Edge Entanglements traverses the borderlands of the community "mental health" sector by "plugging in" to concepts offered by Gilles Deleuze and Felix Guattari along with work from Mad Studies, postcolonial, and feminist scholars. Barlott and Setchell demonstrate what postqualitative inquiry can do, surfacing the transformative potential of freely-given relationships between psychiatrised people and allies in the community. Thinking with theory, the authors map the composition and generative processes of freely-given, ally relationships. Edge Entanglements surfaces how such relationships can unsettle constraints of the mental health sector and produce creative possibilities for psychiatrised people. Affectionately creating harmonies between theory and empirical "data," the authors sketch ally relationships in ways that move. Allyship is enacted through micropolitical processes of becoming-complicit: ongoing movement towards taking on the struggle of another as your own. Barlott and Setchell’s work offers both conceptual and practical insights into postqualitative experimentation, relationship-oriented mental health practice, and citizen activism that unsettles disciplinary boundaries. Ongoing, disruptive movements on the margins of the mental health sector – such as freely-given relationships – offer opportunities to be otherwise. Edge Entanglements is for people whose lives and practices are precariously interconnected with the mental health sector and are interested in doing things differently. This book is likely to be useful for novice and established (applied) new material and/or posthumanist scholars interested in postqualitative, theory-driven research; health practitioners seeking alternative or radical approaches to their work; and people interested in citizen advocacy, activism, and community organising in/out of the mental health sector.
This is the first collection to examine the legal dynamics of deinstitutionalisation. It considers the extent to which some contemporary laws, policies and practices affecting people with disabilities are moving towards the promised end point of enhanced social and political participation in the community, while others may instead reinstate, continue or legitimate historical practices associated with this population's institutionalisation. Bringing together 20 contributors from the UK, Canada, Australia, Spain and Indonesia, the book speaks to overarching themes of segregation and inequality, interlocking forms of oppression and rights-based advancements in law, policy and practice. Ultimately this collection brings forth the possibilities, limits and contradictions in the roles of law and policy in processes of institutionalisation and deinstitutionalisation, and directs us towards a more nuanced and sustained scholarly and political engagement with these issues.
