“The rhetoric was very highfalutin. The reality was a little more complicated, and the funds that were provided were not adequate to the task,” said Steven Sharfstein, president and CEO of Sheppard Pratt Health System, a nonprofit behavioral health organization in Baltimore.
“The goals of deinstitutionalization were perverted. People who did need institutional care got thrown out, and there weren’t the programs in place to keep them supported,” said former U.S. Rep. Patrick Kennedy, the president’s nephew. “We don’t have an alternate policy to address the needs of the severely mentally ill.”
He is gathering advocates in Boston this week for the Kennedy Forum, a meeting to mark the 50th anniversary of his uncle’s legislation and an attempt to come up with an agenda for improving mental health care.
The 1963 legislation came amid other changes in treatments for the mentally ill and health care policy in general, Appelbaum said. Chlorpromazine or Thorazine, the first effective antipsychotic medicine, was released in the 1950s. That allowed many people who were mentally ill to leave institutions and live at home.
In 1965, with the adoption of Medicaid, deinstitutionalization accelerated, experts said, because states now had an incentive to move patients out of state hospitals, where they shouldered the entire cost of their care, and into communities where the federal government would pick up part of the tab.
Later, a movement grew to guarantee rights to people with mental illness. Laws were changed in every state to limit involuntary hospitalization so people can’t be committed without their consent, unless there is a danger of hurting themselves or others.
Kennedy’s legislation provided for $329 million to build mental health centers that were supposed to provide services to people who had formerly been in institutions, as well as to reach into communities to try to prevent the occurrence of new mental disorders. Had the act been fully implemented, there would have been a single place in every community for people to go for mental health services.