mental health disorders
Overview of Mental Illness
Deinstitutionalization
In recent decades, there has been a movement to bring mentally ill people out of institutions (deinstitutionalization) and support them so that they can live in communities. This movement was made possible by the development of effective drugs, along with some change in attitude about the mentally ill. With this movement, greater emphasis has been placed on viewing mentally ill people as members of families and communities. A decision by the U.S. Supreme Court in 1999 significantly aided this change. This decision, called the Olmstead decision, requires states to provide mental health treatment in community settings whenever such placement is medically appropriate. Research has shown that certain interactions between a person with severe mental illness and family members can improve or worsen mental illness. Therefore, family therapy techniques that prevent the chronically mentally ill from needing to be reinstitutionalized have been developed. Today, the family of a mentally ill person is more involved than ever as an ally in treatment. The primary care doctor also plays an important role in rehabilitating and reintegrating a mentally ill person into the community. In addition, because the effectiveness of drug therapy has improved, mentally ill people who end up needing to be hospitalized are less likely to need to be put into seclusion or physically restrained than in the past. Also, they are often discharged within days into day treatment centers. Day treatment centers are less expensive than inpatient institutions because fewer staff members are needed, the emphasis is on group therapy rather than individual therapy, and people sleep at home or in halfway houses rather than in a hospital. However, deinstitutionalization has had its share of problems. The necessary treatment and protection from harm that was provided in institutions has not been adequately replaced by community mental health services because of insufficient funding. Thus, many people have not been able to get the mental health care that they need. Moreover, laws now prevent mentally ill people who are not a danger to themselves or society from being institutionalized or medicated against their will, which is a particular problem since some serious mental disorders are characterized by a lack of awareness that the person has a mental health problem (anosognosia). Thus, many people who become ill again outside the hospital become homeless or end up in prison. Many die young because of exposure, infection, or inadequately treated medical problems. Although these laws protect people’s civil rights, they make it more difficult to provide needed treatment to many mentally ill people, some of whom may be extremely irrational when untreated. Because of the problems related to deinstitutionalization, novel approaches to treatment, such as assertive community treatment (ACT), have been developed. They help provide a safety net for people with chronic serious mental illness. ACT uses a team of social workers, rehabilitation specialists, counselors, nurses, and psychiatrists (a multidisciplinary team). The team provides individualized services to people who have a serious mental illness and who cannot or will not go to a doctor's office or to a clinic for help. The services are provided in the person's own home or neighborhood—for example, in nearby restaurants, parks, or stores. 