Facilitating Deinstitutionalization: a Comparative Analysis

The purpose of the paper is to highlight issues related to deinstitutionalization and community care of the mentally ill by using a comparative approach. Through a comparison of the trends in the U.S.A. and Israel, an attempt is made to account for factors which pro moted deinstitutionalization. The paper focuses on specific policies and programs which were crucial in reducing the rate of resident population in mental institutions and facilitating the development of community care for the mentally ill in the U.S. It points out the environ mental conditions, social, political, legal and organizational, which may be conducive to legis lative and administrative actions in order to facilitate deinstitutionalization. It is now evident that during the last two decades the mental health service system has gone through a profound change. This change has occurred mainly in the western world and perhaps is most visible in the U.S. In recent years we have witnessed the gradual decline of the state hospital as the hub of the mental health system. At the same time the number and utilization of community-based services have been steadily increasing. Closely related, or even synonymous, to these trends, are the movement for community care and deinstitutionaliza tion. These movements have gained a great deal of interest among professionals and lay public alike. 9 This interest has been manifested in a large number of articles on the various aspects of these movements. Delineating, categorizing and putting these issues in a conceptual and a theoretical perspective has become a task in itself. 7 The purpose of this paper is to highlight some of the issues related to deinstitutionaliza tion and community care by using a comparative approach. Through a comparison of the trends in the U.S. and Israel an attempt will be made to account for factors which promoted deinstitutionalization. The paper focuses on trends which affected the reduction of resident population in mental institutions and facilitated the development of community care system for the mentally ill.