Parade of Freaks? Deinstitutionalization and the Homeless with Mental Illness

Hang around almost any urban public library for any length of time these days, and it quickly becomes apparent that a significant number of the so-called “problem patrons” are suffering from some combination of mental health issues, substance abuse, and/or homelessness. Although seemingly one-sided, Library Woes does a great job of depicting the wacko scenarios many librarians deal with daily at public libraries - places which often seem to serve more as de facto homeless or daycare facilities, than institutions dedicated to education, enlightenment, literacy, democracy and so on. Where does this Parade of Freaks, as Library Woes puts it, come from? Part of the answer may lie in the deinstitutionalization movement.

What is deinstitutionalization?

In the United States, deinstitutionalization refers to the long-term reorganization of mental health care beginning during the 1960’s, wherein patients were shifted out of psychiatric and public hospitals and treated as outpatients via community-based mental health centers. Advocates of deinstitutionalization characterized this shift as liberating and underscored the fact that inpatient mental health care was restrictive and ineffective. Some have also emphasized the invention of new psychiatric medications and their ostensible role in reducing the demand for inpatient mental hospital care. In practical terms, deinstitutionalization means a reduction in the scope of mental health care from longer inpatient to shorter outpatient treatment (Kemp 19-27). Partially due to insufficient funding for community-based mental health care, it has also been tied to the issue of homelessness. In 1990, for example, the Public Citizen Health Research Group and the Alliance for the Mentally Ill released a report that the number of people with untreated mental illness living on the streets, in public shelters, substandard boarding houses, transient hotels or in jails was higher than it had ever been since the 1820s. However, many argue that although homelessness among those with serious and/or chronic mental illness is associated with deinstitutionalization, the problem is not due to deinstitutionalization per se, but rather to the specific way in which deinstitutionalization has been carried out. In 1984, Dr. Richard Lamb observed that insufficient plans for structured living accommodations as well as for community-based treatment and rehabilitative services had “led to many unforeseen consequences such as homelessness, the tendency for many chronic patients to become drifters, and the shunting of many of the mentally ill into the criminal justice system.”

Kemp, Donna R. Mental Health in America: A Reference Handbook. Santa Barbara: ABC-CLIO, 2007.

Lamb, H. Richard. “Deinstitutionalization and the Homeless Mentally Ill.” Hosp Community Psychiatry 35 (September 1984): 899-907.

Torrey, E. Fuller, Karen Erdman, Sidney M. Wolfe, and Laurie M. Flynn. Care of the Seriously Mentally Ill: A Rating of State Programs. Washington, DC: Public Citizen Health Research Group and National Alliance for the Mentally Ill, 1990.