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How the Community Care movement resulted in an epidemic of homelessness.
…Deinstitutionalization is at the very least a work in progress if it has begun at all…
Hamlin and Oakes Reflections on Deinstitutionalization in the United Kingdom – 2008
1984. England. A scathing report emerges: the structure of the National Health Service is woefully broken, specifically when it came to the care of people with intellectual disabilities. The recommendation: completely restructure the NHS’ management system to make each link in the system, from doctors to the Secretary General, responsible and accountable for care in the U.K.
Why did this report, known as the Griffith’s report, recommend such immediate and sweeping changes to the nation’s healthcare system?
After all the English Care in the Community Movement had been a great success – a huge portion of patients had been moved from institutions to the care of local authorities. In the mental health field, asylums were becoming a thing of the past. All good news, right?
Table of Contents
The Problem with Community Care
The problem: In the 20 years since deinstitutionalization began, local healthcare systems proved to be woefully unprepared to receive the massive influx of mental health patients coming out of asylums.
Furthermore – since the NHS was bloated and mismanaged, according to the Griffith’s report, no one department took responsibility for creating and maintaining the network of Community Care.
And no one was held accountable for the failure of the movement.
Care in the Community: A Failure?
Basically, the laws changed, but no follow up action was really achieved. Care in the Community became everyone’s distant cousin but no one’s baby.
According to the U.K. Department of Health via Hamlin and Oaks in their 2008 paper Reflections on Deinstitutionalization in the United Kingdom, “the closure of hospitals in the U.K. has not led to a large number of people living in their own homes.”
I.e. the people who need the most care are now living in congregate settings (group homes) and/or are chronically homeless.
Homelessness in the Western World
The issue is largely the same in the United States
“Homeless people in Western countries are substantially more likely to have alcohol and drug dependence than the age-matched general population in those countries, and the prevalences of psychotic illnesses and personality disorders are higher.”
Favel et al: The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis – 2008
As asylums began to close in the U.S. in the 50’s and 60’s, there was supposed to be a corresponding movement to build government funded hubs of community level care across the nation.
Unfortunately, this didn’t happen. Unlike in the U.K. we didn’t have a national health system to provide funding, manpower, or housing for community mental health centers.
So in the U.S. only a fraction of the proposed community mental health centers were ever built – and none of them were ever funded.
The result: people continued experiencing immense mental health problems but now they had no where to go. They ended up on the streets, creating the widespread epidemic of homelessness we still see in the U.S. to this day.
What can be Done?
As we can see, the problem wasn’t actually in Community Care Movement itself – it was in the mis-execution: a great idea with little to no follow through.
There is hope in our modern world though: theories abound how to make Community Care work with our current system. Most require a huge systemic overhaul – not unlike Griffith’s recommendation in 1984 for the NHS. However that would be kind of impossible in a country the size of the U.S.
But as Americans, if anything, we’re crafty, scrappy, and ingenious when it comes to finding a different way to solve a complex puzzle. JFK said it himself, “there’s no problem created by man that can’t be solved by man.”
So stay tuned, we’ll be exploring some of these creative solutions next time in Part 4 of our series.
Thanks as always for reading!
Best,
MB
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In Europe the movement of Community Care should be on the rise. While decreasing places in institutions other options should open up. Only there is the chance to save some money. More patients, less workers. The people who really need the care, are the most likely to miss out on the new opportunities.
They are also creating a ‘budget’ per person, based on ‘points of care needed’ and they want to be more transparent with the money, sometimes ‘giving’ it to people who are responsible to spend their ‘care-budget’. I’ll wait and see how that goes but ….. I’m very sceptic. I hope you can set a better example for us.
I hope so too! A care budget is something we actually do over here-it’s called a Health Savings Account and it works well for a lot of people.
Oh, that is one good perspective then. I hope it will work here too. 🙂
They talk about giving the money to the patient and let them decide how best to spend it over here in the UK but I’m not so sure it’s a good thing. Patients often have enough confusion dealing with the small amount they get and unfortunately here, many of our patients are often abused by drug dealers etc – they move into the patients’ homes and take their money.