Abstract
Between the 1940s and the 1970s mental health policy in the United States underwent a fundamental change as the legitimacy of institutional care was undermined by individuals and groups committed to an environmentalist psychodynamic and psychoanalytic psychiatry and to community-oriented programs. The consequences of the policy changes during these decades, however, differed in significant respects from the goals and intentions of those who favored innovation. This paper sketches out the dynamics of policy changes from World War II to the 1970s.
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For a fuller explication of the views presented in this paper (as well as extensive documentation of sources), see my bookFrom Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991). I have not dealt with the introduction of the psychotropic drugs in the early 1950s, which many assume began the process of “deinstitutionalization.” Without going into a great deal of detail, it should simply be noted that there is persuasive statistical evidence that the decline in state mental hospital populations immediately following the introduction of the psychotropic drugs was relatively modest; the greatest decline occurred after passage of Medicaid and Medicare in 1965.
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Gerald N. Grob is Henry E. Sigerist Professor of the History of Medicine, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
The research for this paper was supported by NIMH grant MH-39030.
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Grob, G.N. From hospital to community: Mental health policy in modern America. Psych Quart 62, 187–212 (1991). https://doi.org/10.1007/BF01955796
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DOI: https://doi.org/10.1007/BF01955796