Homelessness and Mental Illness in the 1980s: The American Psychiatric Association Task Force Report

Despite the intense federal focus on the condition of the severely mentally ill in the late 1970s, the new decade began with mental health care largely left up to the states. The process of emptying state hospitals continued, with general hospital psychiatric services becoming the mainstay for episodes of illness experienced by state hospital discharges as well as those with an early episode of severe mental illness (Bachrach, 1981).

In the early 1980s, the United States experienced high unemployment, double-digit inflation, and gentrification of low-cost neighborhoods that reduced the availability of affordable housing—unwelcome conditions for people with disabilities trying to make a go of it in the community. During this time, reports of homeless and often mentally disturbed people wandering city streets or seeking shelter in public places were widespread across the nation (Baxter & Hopper, 1981; Carmody, 1981; Hombs & Snyder, 1982). A study of homeless people seeking assistance from a New York City emergency department revealed that most were mentally ill with psychiatric hospitalization histories (Lipton et al., 1983). A study conducted in a Philadelphia shelter for the homeless revealed a similarly high rate of mental illness among its residents (Arce et al., 1983). Although community-wide data were sparse, the mentally ill among the rising number of homeless poor existed in substantial numbers.

By 1983, the extent of the problem of homelessness among the mentally ill prompted the American Psychiatric Association (APA) to set up its Task Force on the Homeless Mentally Ill to assess the problem and devise a set of recommendations. Acknowledging psychiatry’s responsibility to the mentally ill among the homeless (Lamb, 1984), its broad range of recommendations on services, training, and research included the development of supervised housing, and access to rehabilitation and psychiatric services provided through outreach when necessary (Lamb, 1984). In comments about the recommendations to the press, the APA declared that the practice of releasing people with mental illness from state mental institutions into communities that were poorly prepared to accept them had been a failure and “a major social tragedy.” All levels of government, the profession of psychiatry, and mental health professionals were held to account for failing to provide adequate funding for health care and social services, and for shying away from caring for the most disabled patients (Boffey, 1984).

It was hoped that community mental health treatment would offer greater benefits than institutional care for the majority of patients with severe mental illness. While some had been able to live successfully in the community, the community service system had failed to respond to the service and support needs of a population suffering from serious and long- lasting mental disorders. Leona Bachrach (Bachrach, 1984) observed that, although the rise of homelessness among the severely mentally ill was linked to the policy of deinstitutionalization, the problem was not simply the policy itself but the absence of careful planning for the housing and service needs of discharged patients as the policy was implemented. There is no question that changes in the funding of mental health services and the increase in civil liberties for people with severe mental illness exerted a marked influence on the service system and how it was utilized.

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