In the early days of deinstitutionalization, patients who had close ties with their families often returned to family living settings after they were discharged. For others, long-term institutionalization had frayed their relationships with their family and kin, and many could not count on their families for housing or sustenance when they returned to the community. Some were inappropriately placed in nursing homes (Melick & Eysaman, 1978). Others were priced out of the rental housing market and often confronted with discrimination. In some cities, the options for discharged patients on public entitlements consisted mostly of for-profit board and care homes, group homes, or large, multi-bed, proprietary adult homes, business enterprises requiring considerable capital investment and concerned about costs and profits. Staff were typically untrained and lacking in therapeutic skills. Reports of inadequate care and exploitation in these settings were common (Caton et al., 1990; Segal & Aviram, 1978; VanPutten & Spar, 1979), and they were often located in rundown and unsafe neighborhoods that exposed their tenants to violence and drug use. By the mid-1970s, the need of the severely mentally ill for adequate housing was recognized in federal mental health policy. A 1975 amendment to the Community Mental Health Centers Act (Title III, Public Law 94-63) included the community residence as one of the essential services of a community mental health center, but no such facilities were ever developed.[1]

By the late 1970s, the sight of people seeking shelter in transportation depots, in church doorways, under bridges, in public parks, and on the heating grates of modern office buildings became commonplace in urban centers across America. Some cities had shelters or missions operated by private or nonprofit agencies, but they could serve only a small, select portion of those in need. The success of advocates in Washington, D.C., in obtaining an unused federal building to shelter the homeless, and in winning the legal right to shelter in New York City, presaged the provision of federal funding for emergency shelter services in the McKinney-Vento Homeless Assistance Act of 1987 (see Chapter 2).

  • [1] Community mental health centers were never fully funded or implemented nationwide. Mental health center funding was folded into block grants to the states by theReagan administration.
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