Some perspectives on deinstitutionalization

The authors discuss what can be learned from our experience with deinstitut ionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the commun ity, their diversion from hospital admission, and the development of altern ative community services. The greatest problems have been in creating adequ ate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have s ignificantly benefited. On the other hand, there have been unintended conse quences of deinstitutionalization-a new generation of uninstitutionalized p ersons who have severe mental illness, who are homeless, or who have been c riminalized and who present significant challenges to service systems. Amon g the lessons learned from deinstitutionalization are that successful deins titutionalization involves more than simply changing the locus of care; tha t service planning must be tailored to the needs of each individual; that h ospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved i n their service planning; that service systems must not be restricted by pr econceived ideology; and that continuity of care must be achieved.