INSTITUTIONALIZATION

OF THE MENTALLY ILL

Institutionalization of the Serious Mentally Ill

Mackenzie Belton
The University of North Carolina at Charlotte

INSTITUTIONALIZATION OF THE MENTALLY ILL

The Beginning
When asked, should individuals with a mental illness be institutionalized? My
quick response would be no. However, after careful research I have come to the
conclusion that there really is not an answer; it solely depends on the situation and the
individual. Since the mental illness spectrum is so wide and it goes from one extreme to
the next, it is impossible to group all of the illnesses together into one category.

My Personal Experience
You might be asking how this has any relevance to me. My grandpa was
diagnosed with a SMI, Schizophrenia, in his late fortys. For a short period of time he
was in a psychiatric care and he was treated very nice there and he was treated for
properly. It seemed as though he was getting better so he went through the
deinstitutionalization process and was put into an apartment-assisted living. He did not
have around the clock care and supervision that was needed. He ran out of food and he
missed meals and sometimes his medication. He became violent and would leave the
apartment without any help or supervision. He did not have a routine that he was so
use to in the psychiatric hospital. This was not a proper place for him and his disease.
He was finally put back into the psychiatric institution where he had correct
supervision and someone to tell him when it was time to eat and when it was time to
take his medicine and he became himself (for the most part) again. My grandpa lived
most of his adult life in a mental institution and it truly helped him lead a better life.

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What Is It?
Lets start from the beginning. What is a severe mental illness? A severe mental
illness (SMI as I will refer to it throughout my argument) is anyone that has a
diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet
criteria in the DSM-III (which is Diagnostic and Statistical Manual for Mental Disorders,
the third edition) that has resulted in functional impairment of everyday life activities.
These are illnesses like anti-social disorder, schizophrenia, and other personality
disorders. Now, what is institutionalization? Institutionalization is simply the process of
treating someone with a mental illness by placing him or her in an institution, such as a
psychiatric hospital. A person with a SMI needs to be institutionalized for three reasons
in particular. If they arent instituted it can (1) lead to homelessness and violence as
well as (2) being misplaced in nursing homes and general hospitals that doesnt give
them adequate care. The final reason is (3) if they are instituted they are more likely to
obtain proper care and treatment due to the neediness of their disease. These three
reasons, as I will elaborate in further detail in a second, all contribute to the idea that
SMI individuals are better off being institutionalized.

Deinstitutionalization
When a person with a serious brain disorder is taken out of a large, state mental
institution and placed somewhere, whether it is short-term or long-term, to seek other
treatment is called deinstitutionalization, (pretty much the opposite of
institutionalization). Since this policy was established in the 1950s and 1960s, it has

INSTITUTIONALIZATION OF THE MENTALLY ILL

become a major contributing factor in homelessness, incarceration, and acts of violence.

According to the National Advisory Mental Health Council, 40 percent of individuals
(1.8 million) with serious brain disorders such as schizophrenia or manic-depressive
illness are not receiving treatment on any given day, which results in their illness
worsening. If they arent receiving medication or having any kind of treatment such as
therapies, this increases their likelihood of homelessness, violence, and incarceration.
There are a lot of fingers to point for this and one of them is pointing towards failure of
deinstitutionalization, partly due to economic issues (Mental Illness Policy Org., n.d.).
With that being said, A lot of harm can come from being deinstitutionalized and not
only harm to that individual but to the people around them as well. It is important for a
person with a SMI to be institutionalized because it is just that, severe. It is a serious
matter and it is not something that just goes away with time.

Why Institutionalizing SMIs is Better

The second reason why individuals with SMIs should be institutionalized
because it is said that those with SMIs are better off in an environment (like a
psychiatric hospital) that can manage their disorder as opposed to someone with a less
serious disorder. Many people with intellectual disabilities or even non-serious mental
illnesses such as depression or eating disorders have straightforward basic needs,
which can be administered outside of a mental institution. There are group homes and
community interaction programs in which these people can go to in order to seek
emotional support. Not the same can be said regarding SMIs. SMI patients need more

INSTITUTIONALIZATION OF THE MENTALLY ILL

episodic care and there arent a lot of places that can offer care like that (only
psychiatric institutions). As far as community programs, there are no equivalent for
those with a SMI and there are no funds or public acceptance to create a program of the
sort (Pollack, 2013). It seems as if individuals with a serious mental disorder are being
discriminated against because their disorder is harder to control and not socially
accepted, and I agree that there is an injustice between the two categories. However,
these people that are being discriminated against deserve to be in a place where they
are accepted and treated for in all ways possible, and that is sadly a mental institution,
it is not ideal but it works.

Why Not to Chose Deinstitutionalization

Going back to being deinstitutionalized, the act of doing this forced some
patients with a SMI to be transferred to nursing homes or general hospitals. In the
beginning of 1955, a widespread drug known as Thorazine was introduced which had a
lot to do with the transference of the patients. Thorazine is an antipsychotic medication
that was thought to treat schizophrenia and anxiety disorders. With the introduction of
this drug, mental institutions were no longer needed (or so they thought). It turns out
that a pill cannot magically make their disorder disappear; it can alleviate a lot of the
symptoms, but not entirely. These patients were sent to nursing homes and general
hospitals for immediate stay, places like these are not as adequate to care for these
individuals, as they need to be cared for. Someone with a serious mental illness needs,
like I said before, episodic care, supervision, and therapies, along with medication. With

INSTITUTIONALIZATION OF THE MENTALLY ILL

deinstitutionalization, they are forced out of an ideal place of treatment so they have to
go somewhere and in some cases they are put back into the hands of their caregivers,
which could probably be the worst place for them to go (Lamb, 2001). There was a
reason they were put them into a psychiatric hospital in the first place so putting them
back into the hands of the caregiver would mean going back to square one. All of these
circumstances surround the idea that institutionalization is the best possible answer
for people with a serious mental illness.

Stigmas of Mental Illnesses

There are so many stigmas associated with mental illnesses. A stigma is a mark
of disgrace associated with a particular circumstance, quality, or person. The stigmas,
or stereotypes, society puts on the individuals with mental illnesses factors greatly into
them not seeking treatment. It is hard to believe that we have had some contribution to
this at least once in our lifetime. Most people automatically associate a person with a
mental illness with them being violent. However, research suggests that the mentally ill
are more likely to be a victim than the perpetrators of violence. For example, research
from NC State University and Duke University said that people with schizophrenia,
bipolar disorder, or psychosis are two and a half times more likely to be attacked,
raped, mugged than the general public. Another stigma is that people with mental
disorders are unpredictable, this can be true for some but not for all especially if they
are put into a stressful situation. Some people are aware of these stigmas and
stereotypes and to avoid being looked at differently they do not get diagnosed or

INSTITUTIONALIZATION OF THE MENTALLY ILL

treated (Davey, 2013). I hope this can this can give you an idea of how society alone can
affect the mentally ill community, no matter the type of disorder.

The End
In closing, whether you know someone that has a serious mental disorder or you
have a serious mental disorder yourself, it is very important to get all the facts about
institutionalization. Institutionalizing a person with a serious mental illness can help to
avoid violence within the community, homelessness, and incarceration rates. They can
obtain proper treatment and care in an institution due to the severity of their disease
that they couldnt receive elsewhere. Institutionalizing them can also mean not being
deinstitutionalized where they could end up in nursing homes, general hospitals, or into
the care of a family member, which are all not great places for someone with a serious
mental disorder. Stigmas such as they are violent and unpredictable, create negative
consequences within the mental health community. Society stigmatizing the mentally ill
has a huge part in the individuals not seeking treatment due to the insecurities that it
generates from the individual with a SMI. If you get one thing from all of this, get this,
people with mental disorders (especially severe ones) are humans too and they deserve
a healthy life and the only way to do that is putting them in a place where they can
prosper. The only way is by institutionalization. So, do you think individuals with a
mental illness should be institutionalized?

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Reference Page

Davey, Graham. (2013). Mental Health & Stigma. Retrieved March 18, 2015 from
https://www.psychologytoday.com/blog/why-we-worry/201308/mental-health-
stigma
Lamb, Bachrach. (2001). Some Perspectives on Deinstitutionalization. Retrieved February
7, 2015 from http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.52.8.1039

Mental Illness Policy Org. (n.d.) Consequences of not Treating Mentally Ill. Retrieved on
March 15 from http://mentalillnesspolicy.org/consequences/consequences.html

Pollack. (2013). What Happened to Mental Health Care After deinstitutionalization.
Retrieved on March 15, 2015 from
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/12/what-
happened-to-u-s-mental-health-care-after-deinstitutionalization/