According to Rael Jean Isaac and Virginia C. Armat, the shift in care for mentally handicapped patients during the last two decades has caused the patient’s right to receive treatment to be replaced by the patient’s right to refuse treatment. The result is that substantial numbers of people with varying degrees of eccentricity and derangement are living on the streets of the nation.
In 1985, Mayor Edward Koch of New York City ordered metropolitan police officers to remove such people from the streets when dangerously low winter temperatures threatened their survival. Court challenges, however, upheld the right of people to refuse mandatory shelter even in life-threatening circumstances such as freezing to death. Since the Civil Rights movements of the late 1960’s, courts have generally reaffirmed the constitutional rights of all citizens, including mental patients.
The trend to deinstitutionalize surfaced at a time when a host of promising new pharmaceuticals had been developed to treat various kinds of mental disorders from schizophrenia to depression. Because of these wonder drugs, many of the older methods of treatment—mainly psychosurgery such as lobotomies and electrocon-vulsive therapy, the so-called shock treatment—came to be used less frequently than before. Many patients who would have faced a lifetime of confinement in mental institutions a decade earlier were pharmaceutically managed, if not completely cured, to the point that they could rejoin their families and resume their places in the community.
In many venues, led by the initiative of President John E Kennedy, institutions that had been labeled “lunatic asylums” in literature and in common parlance were either shut down or drastically altered. During the Kennedy and Johnson Administrations, federal funding was available to patients being treated in community mental health centers and to mentally disturbed people confined to nursing homes or community residences, but not to those confined in mental hospitals.
Conventional mental hospitals emptied quickly as large numbers of mentally handicapped people found that they could have their conditions treated satisfactorily in the community mental health centers that were now springing up all over the country. Communities responded well to this method of coping with the mentally ill because it is much less costly to staff and maintain community health centers, nursing homes, and community residences than it is to maintain residential mental hospitals. Clients in community centers suffer less social and professional stigma than people who have been confined to mental hospitals. Another immediate social benefit at the beginning of this trend seemed to be that many people who could not function productively were now able, while being treated, to hold jobs and pay taxes rather than being financial drains upon society.
Idealistic dreams about the possible benefits of having a national network of community mental health centers, however, were soon eroded. The staffs of such centers became factionalized, the major split usually coming between the clinicians, who considered it their responsibility to care on a day-to-day basis for the people who came to their centers, and the group that viewed mental illness as a broadly social problem that could be solved only by changing society through eliminating poverty, drug dependence, and other factors that contribute measurably to mental illness.
The internal squabbling within the staffs of community centers prevented many of them from accomplishing their fundamental aims. Racism became a divisive force as the community centers developed. In many communities, the mental health centers were accused of working more with neurotic or mildly psychotic patients than with the deeply psychotic. Obviously, the success rates of professionals who treat slightly ill people will be more impressive than those of professionals who treat the gravely ill. Therefore, many community centers invoked procedures that effectively discouraged seriously psychotic patients from seeking and receiving the long-term, intensive treatment that their conditions demanded. At the same time, such centers were treating substantial numbers of other patients who showed remarkable progress in short periods of time.
Although most professionals in the field applauded the idea of returning mental patients to their own communities whenever they could, many were adamant in saying that it does no good to return such people to the community unless they...
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