The distinguished historian of medicine Gerald Grob analyzes the
post-World War II policy shift that moved many severely mentally
ill patients from large state hospitals to nursing homes, families,
and subsidized hotel rooms--and also, most disastrously, to the
streets. On the eve of the war, public mental hospitals were the
chief element in the American mental health system. Responsible for
providing both treatment and care and supported by major portions
of state budgets, they employed more than two-thirds of the members
of the American Psychiatric Association and cared for nearly 98
percent of all institutionalized patients. This study shows how the
consensus for such a program vanished, creating social problems
that tragically intensified the sometimes unavoidable devastation
of mental illness. Examining changes in mental health care between
1940 and 1970, Grob shows that community psychiatric and
psychological services grew rapidly, while new treatments enabled
many patients to lead normal lives. Acute services for the severely
ill were expanded, and public hospitals, relieved of caring for
large numbers of chronic or aged patients, developed into more
active treatment centers. But since the main goal of the new
policies was to serve a broad population, many of the most
seriously ill were set adrift without even the basic necessities of
life. By revealing the sources of the euphemistically designated
policy of "community care," Grob points to sorely needed
alternatives.
Originally published in 1991.
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