Harold Pollack feels that deinstitutionalization, “the broad set of policies designed to move individuals with disabilities out of large institutions into family- or community-based settings,” was a mixed bag:
On the whole, deinstitutionalization improved the lives of millions of Americans living with intellectual and developmental disabilities (I/DD) — albeit with many exceptions. These policies allowed people to live with proper support, on a human scale, within their own communities. Second, deinstitutionalization was far less successful in serving the needs of Americans suffering from severe mental illness (SMI) — again, with many exceptions.
He also considers the political power of these groups:
[T]he disparities that prove most damaging for public policy reflect disparities in political standing and social stigma between the two groups. People with intellectual disabilities rank among the most appealing constituencies in America. Their well-organized caregivers — people like me — cross every economic, social, and ideological boundary. I cannot imagine, for example, that a policy akin to the IMD exclusion could be imposed on the intellectually disabled.
Similar differences arise in everyday life, as is obvious to any caregiver. Group homes for the intellectually disabled do not face the same “Not in my backyard” problems that beset similar group homes for people with SMI. Constrained by stigma and fear, housing facilities for individuals with psychiatric disorders tend to be larger, more clustered within less-desirable neighborhoods. It’s much harder to attract required funds or public acceptance for best-practice SMI interventions.
Keith Humphreys adds “one gloss about the standard by which we judge the effects of deinstitutionalization on people with SMI”:
If we assume that the pitiable man with schizophrenia on the corner would be in a high-quality, safe, well-staffed state mental hospital if only the country hadn’t deinstitutionalized, we are inventing a past that rarely existed. Granted, it may bother the rest of us more that someone is sleeping in their own waste on the street than when the same thing happens in a back ward of an institution, but that’s because only in the former case do we have to look at such suffering, not because the person themselves is necessarily worse off.
The Dish 