Although the roots of the problems created by the deinstitutionalization of the mentally ill in America go back almost half a century, the effects are still visible today. “Deinstitutionalization” refers to the removal of the mentally ill from state-run mental hospitals. In his article “Shortchanging the Homeless,” Ed Marciniak, the president of the Institute of Urban Life at Loyola University in Chicago, states that this process, which occurred during the 1960’s and into the 1970’s, inadvertently left many mentally ill Americans to fend for themselves (Marciniak). Without sufficient help, many of these mentally ill individuals end up in jail; Marciniak cites a U.S. Department of Justice study released in 1999 which estimates “Sixteen percent of the nation’s mentally ill are likely to be imprisoned” (Marciniak). The problem is clear: the mentally ill in America are not being treated effectively. However, the solution is debatable. A dichotomy does appear to arise from this debate. Should efforts be made to move the mentally ill into state-run mental institutions, or is the solution to have them in community mental health centers? Each side has many valid points.

Many believe that to treat the mentally ill effectively it is important to remove the mentally ill from state-run hospitals and to place them into community mental health centers. Michael Polgar, Ph.D., states in his article “Community Mental Health” that community mental health centers are more effective than state-run mental health facilities in a number of ways: cost effectiveness, accessibility, and responsiveness, to name a few (Polgar). Polgar says that community health centers are more effective and responsive because they seek to integrate mental healthcare into the community rather than to isolate the mentally ill in hospitals. Also, because community health centers are more numerous and various, they are more accessible than large state-run mental hospitals (Polgar). However, for community mental health centers to solve the problems created by deinstitutionalization more funding and legislation is needed (Polgar). In 1963 President John F. Kennedy signed the 1963 Community Mental Health Centers Act, which intended to establish community mental health centers to remove patients from state institutions (Polgar). This was a great step toward deinstitutionalization. However, as Polgar goes on to mention, “[Since then] the goals and practices of community mental health have been complicated and revised by economic and political changes” (Polgar). Funding was inadequate and mental hospitals were downsizing too quickly for community centers to keep up. The result was a large number of mentally ill men and women unable to find care or treatment (Marciniak). As mentioned earlier, many of these individuals ended up in jail. Many others ended up homeless. With the help of more legislation like the 1963 Community Mental Health Centers Act, perhaps some of the problems created by the mismanagement of deinstitutionalization could be corrected.

On the other end of the spectrum is what might be called re-institutionalization. Some say that the best solution is not to keep patients out of state-run mental hospitals; it is to get them in. An entry in the fourth edition of the Encyclopedia of American Industries entitled “SIC 8063: Psychiatric Hospitals” states that during the time period between 1984 and 1991 the number of hospital admissions actually increased 27%. However, in the late 1990’s another attempt at deinstitutionalization can be seen, as there were 43,497 hospital beds in 1995, and only 29,937 in 1999. This is a decrease of over 30% in only four years (“Psychiatric Hospitals”). Also noted in this entry is “Controversyas to the appropriateness of care for the mentally ill living in and seeking treatment in nursing homes” (“Psychiatric Hospitals”). Polgar says that even community mental health centers are not designed for the people with severe mental disorders (Polgar). Nursing homes are surely ill-equipped to treat such people. Unfortunately, many individuals with severe mental disorders are having trouble gaining admission to mental hospitals because of the decrease in availability of inpatient care. These people are better off in community mental health centers or in nursing homes than on the streets. However, they may not be getting proper treatment for their disorders in these places. Legislation and funding are the solutions in this case, as well (“Psychiatric Hospitals”). Without the proper laws and funding, the number of beds available in mental hospitals will not increase enough to solve the problems created by deinstitutionalization.

The two aforementioned solutions to the problems created by deinstitutionalization, more funding for community mental health centers or more funding for state-run mental hospitals, may appear to be polar opposites; however, these ideas are not mutually exclusive. A third solution would be to give more funding to both. Both mental hospitals with inpatient care and community mental health centers are needed to most effectively and most efficiently treat the mentally ill population (Polgar). After all, different jobs require different tools. It wouldn’t make sense to give a carpenter a sewing needle to build a house with, nor would it be practical to give a tailor a hammer to take in a pair of pants. The situation here is not so different. The severely mentally ill need advanced inpatient care they can only receive at a mental hospital. Likewise, those who have more mild disorders and those who are attempting to reenter society are not going to do as well in a mental hospital as they would in a community mental health center, where they can be given proper treatment and have more freedom. This is a fact that Polgar agrees with. He admits that community health centers are meant to supplement mental hospitals, not to take their place (Polgar). Once again, what is needed to make this solution a reality is legislation and funding. Without these things, not much is possible.

It is obvious that the third and final solution is the best, as it incorporates the good of the two prior ideas. Perhaps it is a bit idealistic, as funding is inherently difficult to come by. However, with the proper legislation and cooperation from local and state authorities, such a solution is surely possible. The lesson here is one that can be applied to many other instances. When an issue appears to be black and white, if you will forgive the clich, it is important to remember that black and white can coexist. In fact, the opposites often can establish equilibrium, like yin and yang. The mental hospitals are no more and no less important than the community mental health centers when it comes to most effectively treating the nations mentally ill. If one is taken away, the balance is thrown off. The real bottom line when it comes to solving the problems of deinstitutionalization is this: legislation, funding, and a little compromise are needed to have the problems corrected. Finally, as Marciniak points out in his article “Shortchanging the Homeless,” although steps have been made to help the mentally ill in America, greater strides must be made in order to fully correct the problems created by deinstitutionalization (Marciniak).

Works Cited
Marciniak, Ed. “The Homeless Mentally Ill.” Opposing Viewpoints Resource Center.
Detroit: Thomson Gale, 2005. Opposing Viewpoints Resource Center. Thomson Gale. Suffolk Community College - SUNY. 10 Nov. 2007
Polgar, Michael, Ph.D. “Community mental health.” Gale Encyclopedia of
Mental Disorders. Eds. Ellen Thackery and Madeline Harris. Vol. 1. Detroit: Gale, 2005. Gale Virtual Reference Library. Thomson Gale. Suffolk Community College - SUNY. 10 Nov. 2007
“SIC 8063 Psychiatric Hospitals.” Encyclopedia of American
Industries. Ed. Lynn Pearce. Vol. 2: Service and Non-Manufacturing Industries. 4th ed. Detroit: Gale, 2005. Gale Virtual Reference Library. Thomson Gale. Suffolk Community College - SUNY. 10 Nov. 2007