Deinstitutionalization

Deinstitutionalization emphasized the independent living of individuals who were once hospitalized. This movement, as it is often called, pushed for the mentally ill to be viewed as members of families and communities instead of residents in institutions and asylums (Krieg, 2001; Porter, Kaplan, & Homeier, 2009).

A number of factors led to the deinstitutionalization of many individuals including the use of psychotropic drugs and a number of court cases which ruled in favor of more rights and greater freedom for mental patients.

Neuroleptics

  • Widespread use of drugs in the mid-1900s including Thorazine in 1955 led to the release of many patients from psychiatric hospitals (Krieg, 2001). Thorazine, also known as Chlorpromazine, is most often used to treat schizophrenia. However, it has also been used to treat symptoms of mania in individuals with bipolar disorder and to subdue aggressive behavior and hyperactivity in children (National Institutes of Health, 2008).
  • Less conventional uses of the drug include: to control vomiting and nausea, relieve hiccups that have lasted more than a month, to relieve restlessness and nervousness associated with patients about to undergo surgery, or to treat tetanus (National Institutes of Health, 2008).
  • This type of drug use (using Chlorpromazine to treat schizophrenia) became known as neuroleptics, and its use has sparked many debates. Developed in 1954, it originally appeared to be beneficial for those who had schizophrenia because it lessened the effects of the illness. Many studies were conducted and praised the results of neuroleptics because it allowed patients a release from the illness (Whitaker, 2009).

The use of neuroleptics has sparked many debates.

  • In reality, however, it was found that neuroleptics were only good for the short-term. Many longitudinal studies found that those who were not medicated with neuroleptics eventually had less depression, blunted emotions, and retarded movements.  They were found to have higher standards of living and even recovered at a faster rate over the long-term than those who were taking neuroleptics.
  • If patients were prescribed neuroleptics there was very little hope for them if they came off of the drug.  The drug only appeared to be effective if taken consistently and hurt the person if they were taken off of it (Whitaker, 2009).

Court Decisions


  • A number of court decisions also played a role in the release of psychiatric individuals. Shelton v. Tucker in 1960 led to the establishment of the “least restrictive alternative,” a law that allows for involuntary admission to psychiatric hospitals only if there are no other types of treatment that would provide more freedom to patients. Similarly, the O’Connor v. Donaldson case in 1975 ruled that non-dangerous mental patients have the right to be treated or discharged if they have been institutionalized against their own will (Krieg, 2001).

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Kreig, R. G. (2001). An interdisciplinary look at the deinstitutionalization of the mentally ill. The Social Science Journal, 38, doi: 10.1016/S0362-3319(01)00136-7

National Institutes of Health, National Center for Biotechnology Information. (2008). Chlorpromazine.

Porter, R. S., Kaplan, J. L., & Homeier, B. P. (2009).  The MERCK Manual Home Health Handbook. Whitehouse Station, NJ, US: MERCK Research Laboratories.

Whitaker, R. (2009). Deinstitutionalization and neuroleptics. In Y. O. Alanen, G. dC. Manuel, A. S. Silver, & B. Martindale (Eds.) Psychotherapeutic Approaches to Schizophrenia Psychoses: Past, Present, and Future, (pp. 346-356). New York, NY, US: Routledge/Taylor and Francis Group.

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9 Responses to “Deinstitutionalization”

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  4. Patricia says:

    Your information was very useful for my research paper on deinstitutionalization of the severely mentally ill.

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  6. Sally says:

    In 1973, a federal district court ruled in (Souder v. Brennan) that patients in mental health institutions must be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938 whenever they performed any activity that confered an economic benefit on an institution. Following this ruling, insitutional peonage was outlawed as evidenced in the Pennsylvania’s Institutional Peonage Abolishment Act of 1973.

    Many assume that the advent of modern psychotropic medications was the catalyst for deinstitutionalization in the U.S. However, large numbers of patients began leaving state institutions only after new laws made unpaid patient labor illegal. In other words, when patients no longer worked for free, the economic viability of many state institutions ceased and this led to the closing of many state hospitals. In an ironic twist, patients’ unpaid labor had, for decades, helped prop up and support the existence of the very institutions that held them captive.

    http://www.patdeegan.com/blog/posts/lead-shoes-and-institutional-peonage

  7. Liz Caralyus says:

    Also, Brewster v. Dukakis, F.2d 1 (1982)

  8. Liz Caralyus says:

    Your information on Shelton v. Tucker is incorrect. The case is O’Connor v. Donaldson, 422 U.S. 563 (1975).

  9. rose says:

    Your information has been very useful for my presentation on Abnormal Psychology. Thank you very much.

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