The movement toward deinstitutionalization in twentieth century America

Hey Insiders, welcome to the Well. In tonight’s post I am going to talk about the movement away from institutionalization of the mentally ill. This is a super brief overview, but can help shed some light on the trajectory from institutions to more community based treatments.

In the first half of the twentieth century, institutionalized mentally ill had to rely solely on dangerous treatments, such as electroconvulsive therapy, insulin coma therapy, and lobotomies, which caused significant damage. In retrospect, these treatments seem cruel and unethical, however, at the time they represented the modernization of psychiatric treatment. One source states, in reference to lobotomy, that, Due to the number of complications and deaths that resulted from the procedure, it was referred to as “psychic mercy killing” and “euthanasia of the mind.”” This was by far mental health care’s darkest hour.”

The advent of drug therapy in 1954 was a turning point in the treatments used in institutions. The introduction of Thorazine, which was the first in a rapid development of new psychiatric drugs, changed attitudes toward the possibilities for mentally ill individuals. With symptoms being under control, patients has significantly decreased stays in institutions. Psychiatric drugs instilled hope that the mentally ill could exist in the community, and was the first step towards making community based treatments a possibility.

Another factor that contributed to the movement toward community based treatment was in 1963, when President John F. Kennedy implemented the Community Mental Health Centers Act. As a result of this act, $150 million dollars was allotted to develop more community based mental health treatment. This shift was made because of increased awareness of the harsh environment in mental health institutions, and the development of new drugs which made it easier for individuals with mental illness to live in the community.

Since then, mental institutions have closed in large numbers. In 1993 we saw a higher amount of the state’s money for mental health allotted to community care rather than institutions. People with mental illness still experience discrimination in health care. We must remember the positive progress that has been made, and continue to seek ways to increase the fair and ethical treatment of any vulnerable population.


I’d love to read any thoughts or feelings in the comments. Thanks for stopping by the Well!

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