Deinstitutionalization and Homelessness

The deinstitutionalization of the Reagan era is notorious for its failure to one of society’s most vulnerable people: the mentally ill. Psychiatrists and doctors saw some patients who were misdiagnosed receive lobotomies; around fifty-thousand lobotomies were performed by the end of the 1950s. Politicians abused this fact to oversell community health clinics and promise more funding than intended, in order to save money on state mental institutions. Drugs were used as an elixir, a crutch to ease the transition from in-house treatment to community treatment. The accelerated deinstitutionalization coupled with Congress’s lack of long-term financial support led to the homelessness problem we find in our communities today.

Richard D. Lyons of the New York Times wrote on the 1986 reflections of various politicians, civil libertarian lawyers, and psychiatrists on the transition from treating patients in-house. Some pointed to a dependency that state programs developed on tranquilizers to treat patients. Drugs like Thorazine were advertised as a means to end violent episodes, but doctors misrepresented them as a means of complete treatment. Critics and proponents of deinstitutionalization alike understood the enthusiasm for the tranquilizers. Prior to medication, disorders like schizophrenia and manic depression went un- or mistreated. It was at this point that the families and friends of the discharged patients (those lucky enough to have a home to go to) had the hope of communal help and sovereign remedies.

Mental illness, treated and untreated alike, can result in pushing away family, caregivers and friends, a safety net that often prevents homelessness. Today, the Diagnostic and Statistical Manual for Mental disorders (DMS) has a drug for the most outlandish of disorders. One study by the SAMHSA Spending Estimates Project showed that in 1986, 7% of the $32-billion mental health budget was used for drugs, compared to the 27% of the $113-billion budget of 2005; in-patient spending plopped from 42% to 19%, respectively. According to S W Schondelmeyer in the journal Health Affairs, the cost of prescription drugs has increased by 25% since 1985. The caregivers of the mentally ill were left with the growing cost of medication with none of the promised local help. Safety nets tore, exposing the vulnerable to the streets and to their limitations as a functional member of society.

There is a trustful dependence on drugs to treat the mentally-ill in American society, a job once believed to be that of the community. Homelessness is not limited to those diagnosed with a psychiatric disorder, but many homeless people suffer addictions (eg. alcoholism) and/or traumas (eg. veterans). The high cost of drugs and therapy often act as a barrier to accessible healthcare. There should be a greater emphasis for affordable housing on the part of the social worker and the community. The first step towards a solution is recognizing the limitations of drugs compounded with an effort to identify the care needed for each individual case. Congress should fulfill the promises made by decades past and finance the mental health programs necessary to work towards a solution.