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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