https://en.m.wikipedia.org/wiki/Deinstitutionalisation
With the closing of these state mental institutions it has become increasingly difficult for people who suffer from severe mental illness to receive treatment in a facility. Many mentally ill individuals were left homeless after Deinstitutionalization, making up one-third of the homeless population (D.E. Torrey). Today the most prominent treatment for the severely mentally ill is incarceration in a correctional facility, where mentally ill individuals are not receiving adequate care for their disorder.[27]
Community services that developed include supportive housing with full or partial supervision and specialised teams (such as assertive community treatment and early intervention teams). Costs have been reported as generally equivalent to inpatient hospitalisation, even lower in some cases (depending on how well or poorly funded the community alternatives are).[7]
Although deinstitutionalisation has been positive for the majority of patients, it also has severe shortcomings. Expectations that community care would lead to fuller social integration have not been achieved; many remain without work, have limited social contacts, and often live in sheltered environments.[28]
New community services are often uncoordinated and unable to meet complex needs. Services in the community sometimes isolate the mentally ill within a new ghetto, where service users meet each other but have little contact with the rest of the public community. It has been said that instead of "community psychiatry", reforms established a "psychiatric community".[7]
Existing patients are often discharged without sufficient preparation or support. A greater proportion of people with mental disorders become homeless or go to prison.[7] Families can often play a crucial role in the care of those who would typically be placed in long-term treatment centres. However, many mentally ill people are resistant to such help due to the nature of their conditions. The majority of those who would be under continuous care in long-stay psychiatric hospitals are paranoid and delusional to the point that they refuse help, believing they do not need it, which makes it difficult to treat them.[29]
Violence Edit Victimisation Edit Moves to community living and services have led to various concerns and fears, from both the individuals themselves and other members of the community. Over a quarter of individuals accessing community mental health services in a US inner-city area are victims of at least one violent crime per year, a proportion eleven times higher than the inner-city average. The elevated victim rate holds for every category of crime, including rape/sexual assault, other violent assaults, and personal and property theft. Victimisation rates are similar to those with developmental disabilities.[30][31]
Misconceptions Edit Despite perceptions by the public and media that people with mental disorders released into the community are more likely to be dangerous and violent, a large study indicated that those without substance abuse symptoms are no more likely to commit violence than others without substance abuse symptoms in their neighborhoods, which were usually economically deprived and high in substance abuse and crime. The study also reported that a higher proportion of the patients than of the others in the neighborhoods reported symptoms of substance abuse.[32]
Findings on violence committed by those with mental disorders in the community have been inconsistent and related to numerous factors; a higher rate of more serious offences such as homicide have sometimes been found but, despite high-profile homicide cases, the evidence suggests this has not been increased by deinstitutionalisation.[33][34][35] The aggression and violence that does occur, in either direction, is usually within family settings rather than between strangers.[36]