Your text mentions ‘deinstitutionalization’ – a gradual process where mental health in the US shifted from inpatient care in large mental institutions to mostly outpatient care and family- and community-based programs as a result of cost-cutting economic policies in healthcare. The argument was that mental health costs can be greatly reduced if a large numbers of mental patients are deinstitutionalized, and their lives can be improved if they are integrated into their communities. Compared to 1965, the number of Americans with intellectual disabilities who live in large state institutions declined by 85 percent. For many mental health patients, deinstitutionalization indeed, was a dramatic improvement. People with mental health problems are no longer summarily segregated from public schools and summer camps, from gyms and workplaces; they have new laws protecting them, community-based health programs and residential facilities, and often, federal assistance through Medicaid or food stamps programs. And yet, deinstitutionalization turned out to be costly and mental health expenditures grew exponentially from the 1980s. Currently, outpatient services face severe cuts, particularly for non-Medicaid population. Some patients released from large institutions found themselves lacking community support and find it difficult to adhere to a strict medication regimen. Many people with mental health problems live with elderly caregivers (usually parents or family members) who they will likely outlive. Some serious mental disorders are accompanied by substance abuse or result in violent and antisocial behavior.
For this discussion, I would like for you to reflect on both the positive and the negative consequences of deinstitutionalizing the mental health services. Using your own examples, please discuss the intended as well as the unintended consequences of deinstitutionalization. Who benefits, who suffers? What social institutions have to absorb the functions that used to be provided by the state? How does culture at large respond to such changes?
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