Homeless, bewildered, miserable, addicted and sometimes violent: The ranks of the mentally ill are swelling, and many New Yorkers come face to face with the crisis on a daily basis. Behind it lie policy failures half a century in the making.
Prior to the 1950s, our public mental-health system was composed almost exclusively of massive psychiatric institutions run by state governments. The facilities were often overcrowded, and the patients neglected and abused, which led to that approach being phased out beginning in the 1970s.
In its place came outpatient-oriented mental-health care, the model we’re familiar with today; only a very few traditional psych institutions were left standing.
The shift is often referred to as “deinstitutionalization.” Most New Yorkers are familiar with this history. What’s less known is that deinstitutionalization continues to this day.
Under the “Transformation Plan” for New York state’s Office of Mental Health, Gov. Andrew Cuomo’s administration has cut the number of patients admitted as well as the overall bed count in what remains of the state’s traditional network of institutions. The aim is the same as it has been since deinstitutionalization began: humane care at lower cost delivered on an outpatient basis.
Stephen Eide is a senior fellow at the Manhattan Institute and author of the report, Systems Under Strain: Deinstitutionalization in New York State and City.
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