Numerous social forces led to a move for deinstitutionalization; researchers generally give credit to six main factors: criticisms of public mental hospitals, incorporation of mind-altering drugs in treatment, support from President Kennedy for federal policy changes, shifts to community-based care, changes in public perception, and individual states' desires to reduce costs from mental hospitals.
[1] The public's awareness of conditions in mental institutions began to increase during World War II.
Conscientious objectors (COs) of the war were assigned to alternative positions which suffered from manpower shortages.
[1] Following WWII, articles and exposés about the mental hospital conditions bombarded popular and scholarly magazines and periodicals.
During WWII, it was found that 1 out of 8 men considered for military service was rejected based on a neurological or psychiatric problem.
In 1975, the consent judgement was signed, and it committed New York state to improve community placement for the now designated "Willowbrook Class".
[2][3][4][5][6] 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 conferred an economic benefit on an institution.
[1] In general, professionals, civil rights leaders, and humanitarians saw the shift from institutional confinement to local care as the appropriate approach.
[1] During the 1960s, deinstitutionalization increased dramatically, and the average length of stay within mental institutions decreased by more than half.
Intensive outpatient programs are a crucial component of the community-based care that has replaced inpatient hospitalization and institutionalization in many cases.
[11] They are a less time-intensive step down from partial hospitalization, but they can provide greater support than weekly therapy appointments alone.
[12] IOPs can serve as a transition between inpatient hospitalization and less intensive weekly therapy when a patient requires a greater level of care.
[14][15][16] Studies from the late 1980s indicated that one-third to one-half of homeless people had severe psychiatric disorders, often co-occurring with substance abuse.
A process of indirect cost-shifting may have led to a form of "re-institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant.
[19] In summer 2009, author and columnist Heather Mac Donald stated in City Journal, "jails have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly ... at Rikers, 28 percent of the inmates require mental health services, a number that rises each year.