A few days ago the author of Lunatic Fringe commented on the closure of Pennsylvania state hospitals as a positive thing. On the same day however Crazy Mermaid commented on the shortage of psychiatric hospital beds as something negative. These are two rather opposite views on the very same issue: should we be keeping or even building new psychiatric units for people with mental illness or closing them down and sending former patients into the community?

First let me be clear on this: I am all for deinstitutionalization. In this sense I support the closure of state hospitals where long-term patients are usually warehoused without any prospect of ever going back into the community. The solution to the homeless population is not to cover them away into psychiatric institutiotns far away from civilization. That might solve the 鈥減roblem鈥?for the general public who no longer have to see homeless people on the streets but it does not solve the problem for the homeless themselves: while they may now have shelter their quality of life is likely not going to be all that good when warehoused in a state institution.

Unfortunately the presumption behind deinstitutionalization which I see popping up time and time again is the exact reason it doesn鈥檛 work: it is supposed to be cheap. Long-term psychiatric patients are suddenly through some shift in philosophical or political thinking from people who don鈥檛 have mental illness themselves seen as oh so capable of living and working in the community. Go close the state hospitals and discharge the people into 鈥渘ormalized鈥?society. Guess how cost-effective it is to provide them with community-based services? Wow saving money that鈥檚 great!

I see the so-called success rates over at Lunatic Fringe but since there are no statistics I have no clue what a 鈥渧ast majority鈥?is. Even if I had statistics these would not really say much to me because they don鈥檛 communicate the lives of real people in real communities. We do not know what success means. Does it mean the people have a good quality of life or does it mean they are hanging on just enough so that the crisis team won鈥檛 have to take them seriously like I was when I still lived at home? We do not know but I will bet that there are a number of people who fall into the latter category. And then there are the people who do not fall into the 鈥渧ast majority鈥?of success stories. What happened to them? Have they found a warehouse bed in another state institution that didn鈥檛 close? What about the people who weren鈥檛 discharged upon the institution鈥檚 closure?

The presumption of cost-effective community ware sets an artrificial barrier for people to live in the community: only those who are deemed to be cheap enough are being deinstitutionalized and if those who aren鈥檛 cheap enough are being discharged too the risk is high that they will have as miserable lives as they had when living in the institution. These people who cannot hold on to the standards of the rcovery model apparently don鈥檛 matter.

I have said this a million times in reference to people with developmental disabilities already and the same goes for people with mental illness: people need appropriate care'>care in a place they want to live in. Deinstitutionalization is great but it is only great when appropriate individualized community supports are in place. These supports should not just cater to the crazies who really can have a job but no-one bothered to see but also to those who can鈥檛. Warehousing isn鈥檛 good for anyone but we shouldn鈥檛 have to prove how cheap it is to release us in order to be allowed to live in the community.