Clayton Cramer always has great coverage of the intersection of mental health and public policy, and today he linked to an editorial in the WSJ that gives the history of deinstitutionalization in America and how it contributed both to homelessness and crime.
When I entered graduate school in 1972, so pervasive was the push to deinstitutionalize that a newly minted course was added to the mandatory curriculum: Community Psychology, a cobbled-together travesty that stood apart from all my other coursework due to its emphasis on polemics and aversion to science.
The basic premise of Community Psych--that severely mentally ill people could be depended on to show up for treatment voluntarily--never made sense to me. The core of the most common and debilitating psychosis, schizophrenia, is degradation of thought and reason. So the idea that people with fractured minds could and would make rational, often complex decisions about self-care seemed preposterous.
One day, I voiced that opinion in class, questioning if any mechanisms were being set in place to prevent a flood of schizophrenics from ending up on the streets, homeless, helpless, victims of crime and, in some cases, victimizers. The Community Psych professor--one of the liberationists--responded with a patronizing smile and a folksy account of the success of a program in rural Belgium or some such place, where humble working folk created a therapeutic milieu by volunteering to house psychotics in their humble homes and everything ended up peachy.
I didn't challenge what amounted to flimsy anecdotal data, but I did question its relevance to the plight of thousands of severely mentally disabled individuals set loose in vast urban centers. The professor's smile tightened and he changed the subject; and I resolved to get through this joke of a prerequisite and concentrate on becoming the best psychologist possible.
By the time I received my doctorate in 1974, the doors to many of the locked wards had been flung open and the much vaunted community mental health centers were being built--predominately in low-rent neighborhoods. A few years later, government funding for these allegedly humane treatment outposts had been cut, as yet more fiscal belt-tightening was inspired by findings that they didn't work.
To which Mr. Cramer adds:
This Texas Law Review paper by Bernard Harcourt examines institutionalization--as measured by both prison and mental hospital inmates. He makes the shocking discovery that if you combine both measures and plot them against U.S. murder rates for the period 1928-2000, there is an almost perfect negative correlation: as institutionalization (in either prison or mental hospitals) goes up, murder rates go down, and vice versa.
As I wrote myself in the wake of the Virginia Tech slayings, our society of "tolerance" bears some responsibility for the massacre because we were too idealistic to stop Cho Seung Hui before he struck. The problem is that there seem to be so few adults left in the world, and few of them want to sacrifice their lives and reputations to lead our public institutions.